Coding for interprofessional consultations via telephone, internet, or electronic health record

Codes are available in the American Medical Association’s Current Procedural Terminology (CPT) manual to report evaluation and management (E&M) services for consultations provided to a treating physician or other qualified health profession (QHP), performed by another specialized QHP (“consultant”) without face-to-face contact.

Consultations performed via telephone, internet, or electronic health record (EHR) media are covered by the following codes:

• 99446: interprofessional telephone/internet/EHR assessment and management service provided by a consultative physician or other QHP, which must include a verbal and a written report to the patient’s treating/requesting physician or other QHP; five to 10 minutes of medical consultative discussion and review
• 99447: 11 to 20 minutes of medical consultative discussion and review
• 99448: 21 to 30 minutes of medical consultative discussion and review
• 99449: 31 minutes or more of medical consultative discussion and review
• 99451: interprofessional telephone/internet/EHR assessment and management service provided by a consultative physician or other QHP, which must include a written report (no verbal report, as with 99446) to the patient’s treating/requesting physician or other QHP; five minutes or more of medical consultative time

These codes may be reported by a consulting physician or other QHP for either new or established patients and may include, but are not limited to, the following services:

• Clarify the nature of the patient’s problem with the requesting physician or other QHP
• Obtain and review all relevant history, findings, laboratory data, and imaging
• Provide the requesting physician or other QHP with an analysis of the patient’s problem, including alternative diagnoses and management approaches
• Respond to questions from the requesting physician or other QHP
• Provide the requester with all relevant scientific and medical background on the problem
• Provide suggestions for long-term management

Important considerations for reporting consultations
There are several important caveats that physicians and other QHPs should be familiar with to use these codes appropriately. First, the patient for whom the consultation is performed may be either a new patient to the consultant, an established patient with a new problem, or an established patient with exacerbation of an existing problem.

To report the E&M service, the patient should not have been seen by the consultant for a face-to-face encounter within the preceding 14 days. Similarly, if the telephone/internet/EHR consultation leads to another episode of care (e.g., office visit, hospitalization, surgery) with the consultant within the upcoming 14 days, these codes should not be reported. When the sole purpose of the communication is to arrange a transfer of care or other face-to-face service, these codes should not be reported.

Time spent reviewing medical records, laboratory studies, imaging studies, medication profiles, pathology specimens, etc., may be included in the telephone/internet/EHR consultation service and may not be reported separately. Time spent communicating with patients and/or families should not be included.

Importantly, the consultant must document that the majority of the service time reported (greater than 50%) is utilized for a verbal or internet discussion with the QHP requesting the consultation. If greater than 50% of the time for the service is devoted to data review and/or analysis, and less than 50% of the time for the service is devoted to the verbal or internet discussion, codes 99447 to 99449 should not be reported.

Codes 99446 to 99449 conclude with a verbal opinion report and written report from the consultant to the treating/requesting QHP. Code 99451 requires only a written report from the consultant to the QHP requesting the consultation. Service time for 99451 is based on total review of all data and interprofessional-communication time.

Additionally, these codes should not be reported more than once within a seven-day interval. If more than one instance of non-face-to-face contact between QHPs is required to complete the consultation, the cumulative time to review and analyze all data and for all telephone/internet/EHR discussions is reported with a single code.

A written or verbal request for the consultation from the treating/requesting QHP should be documented in the patient’s medical record, including the reason for the request. Consultations of less than five minutes should not be reported.

Physicians should be aware of state-specific licensure requirements when consulting on patients who live in a different state. Physicians may be subject to a Medical Practice Act of the state where the patient resides, even when the consultation is strictly between physicians and there is no direct interaction with the patient. Unless an exception exists in the individual state’s law, the consulting physician is generally required to hold a valid license in the state where the patient is located, unless state-specific exceptions are met.

In summary, several E&M codes are available to reimburse consultants for their time to evaluate patients’ data and communicate findings and recommendations to a QHP requesting their services.

Physicians should familiarize themselves with the specific criteria required to report consultations performed via telephone, internet, or EHR communication systems.

Kevin M. Neal, MD, MBA, FAAOS, is a member of the AAOS Coding Coverage & Reimbursement Committee.

Reference

1. American Medical Association. CPT 2025: Professional Edition. American Medical Association; Chicago, 2025:43-44.