Ntrprof ph1/ntrnet/ehr 5-10
CPT code 99446 covers when a physician or qualified healthcare professional spends 5-10 minutes consulting with another healthcare provider via phone, internet, or electronic health record about a patient's care. This is an interprofessional consultation where one provider seeks another's medical opinion without the patient being present.
RVU breakdown
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
Billing tips
Document exact start and stop times for the consultation period, as 99446 requires 5-10 minutes of medical consultative time. If consultation exceeds 10 minutes, bill 99447 (11-20 minutes) instead for higher reimbursement.
Impact: Using correct time-based code can increase reimbursement by $22.59 (99447 pays $39.73 vs $17.14 for 99446)
Ensure a written report is sent to the requesting provider and documented in the medical record. The report must include recommendations and cannot be an informal curbside consult.
Impact: Missing written report documentation is the #1 reason for denial, resulting in 100% payment loss ($17.14)
Verify the 14-day rule: You cannot bill 99446 if you or anyone in your group practice has seen this patient within the previous 14 days or will see them within the next 14 days for the same or related problem.
Impact: Violating the 14-day rule results in automatic denial and potential audit flags for pattern violations
Obtain appropriate consent from the patient for the interprofessional consultation and document this in the record, as required by many payers.
Impact: Missing consent documentation can trigger denials or audit recoupments of full payment
Bill 99446 only once per patient consultation episode, even if multiple phone calls or messages are exchanged. The total time across all communications determines the appropriate code level.
Impact: Duplicate billing can trigger fraud investigations and require refund of all payments plus potential penalties
Do not bill 99446 for consultations that are part of a formal transfer of care or preoperative evaluations, as these have separate coding requirements.
Impact: Incorrect code selection may result in denial or downcoding to $0 if service is considered bundled or included in other services
Common denials
Lack of written report documentation in medical record - payer audit finds no evidence of formal written consultation report sent to requesting provider
How to appeal: Submit appeal with copy of the actual written report sent to requesting provider, email/fax transmission confirmation, and dated documentation showing recommendations were communicated in writing. Include attestation from consulting physician confirming report was provided.
Violation of 14-day rule - patient seen by same physician or group member within 14 days before or after consultation date for same/related condition
How to appeal: Document that the face-to-face visit addressed a completely unrelated condition with separate ICD-10 codes, or that consultation was requested by outside provider not affiliated with your group. Provide practice documentation showing separate tax ID or NPI to prove independence.
Insufficient time documentation - medical record does not clearly show 5-10 minutes of consultative discussion time was spent
How to appeal: Resubmit with addendum showing specific start/stop times, detailed summary of medical review performed, complexity of decision-making, and all elements reviewed. Include phone logs or timestamp documentation if available.
Service deemed informal curbside consult rather than billable interprofessional consultation - lacks formal request and structured response
How to appeal: Provide documentation showing formal consultation request from treating provider with specific clinical question, evidence of medical record review, written report with specific recommendations, and billing compliance with all CPT requirements for 99446. Cite CPT guidelines distinguishing billable consultations from informal advice.
Frequently asked questions
What is CPT code 99446 used for?
CPT 99446 is used to bill for interprofessional telephone, internet, or electronic health record consultations between healthcare providers that take 5-10 minutes. The consulting provider reviews patient information, discusses the case with the requesting provider, and provides a written report with recommendations without seeing the patient face-to-face.
How much does Medicare pay for CPT 99446 in 2025?
Medicare pays $17.14 for CPT 99446 in 2025 based on the national average non-facility rate. The code has 0.53 total RVUs (0.35 work RVU, 0.15 practice expense RVU, 0.03 malpractice RVU) multiplied by the 2025 conversion factor of 32.3465.
What is the 14-day rule for billing CPT 99446?
The 14-day rule states that you cannot bill 99446 if you or anyone in your group practice has seen the patient within 14 days before the consultation or will see them within 14 days after for the same or related problem. This prevents double-billing when a formal face-to-face evaluation is planned or recently occurred.
Do I need written documentation to bill CPT 99446?
Yes, CPT 99446 requires a written report sent to the requesting provider. This must include your medical opinion and recommendations based on the consultation. Without documented proof of a written report, the service is considered an informal curbside consult and is not billable.
What is the difference between CPT 99446 and 99447?
The difference is consultation time: CPT 99446 covers 5-10 minutes of interprofessional consultation time and pays $17.14, while CPT 99447 covers 11-20 minutes and pays $39.73. You must document actual time spent to justify which code to bill, and should use the code that matches your documented time.
Can I bill 99446 for a phone call with a patient's family member?
No, CPT 99446 is specifically for interprofessional consultations between healthcare providers, not communication with patients or family members. Phone calls with patients/families are reported with different codes (99441-99443 for patient calls, though Medicare doesn't reimburse these separately).
Does CPT 99446 require the patient to be present during the consultation?
No, CPT 99446 is specifically for provider-to-provider consultations where the patient is not present. The consulting provider reviews records and discusses the case with the requesting provider without a face-to-face patient encounter. If the patient is present, different E&M codes would apply.