New York State Medicaid Update - March 2020 COVID-19 Special Edition Volume 36 - Number 4

In this issue …

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COVID-19 Telephonic Communication Services

Effective for dates of service on or after March 13, 2020 during the current State of Emergency only, New York State Medicaid will reimburse telephonic evaluation and management services to members in cases where face-to-face visits may not be recommended and it is medically appropriate for the member to be evaluated and managed by telephone. This guidance is to support the policy that patients should be treated through telehealth including telephonically wherever possible to avoid member congregation with potentially sick patients. Telehealth will be covered for all appropriate services for all patients appropriate to treat through this modality. However, telephonic services are only to be rendered for the care of established patients or the legal guardian of an established patient.

Telephonic evaluation and management services must be provided by a physician, nurse practitioner, physician assistant, or licensed midwife actively enrolled in fee-for-service (FFS) Medicaid or Medicaid Managed Care (MMC) Plans.

If the telephone call follows a clinic/office visit performed and reported within the past seven calendar days for the same diagnosis, then the telephone services are considered part of the previous clinic/office visit and should not be billed separately.

However, if a patient face-to-face visit is not possible due to the State of Emergency, practitioners should assess if telephonic visiting is clinically appropriate to properly care for the patient. In such instances, those visits documented as clinically appropriate by the provider would be considered medically necessary for payment purposes. All other requirements in delivery of these services otherwise apply.

Clinics, including Federally Qualified Health Centers (FQHCs), billing the PPS rate should bill telephonic evaluation and management services as ordered ambulatory.

Relevant CPT codes are:

  • "99441": Telephone evaluation and management service; 5-10 minutes of medical discussion
    Fee: $12.56
  • "99442": 11-20 minutes of medical discussion
    Fee: $23.48
  • "99443": 21-30 minutes of medical discussion
    Fee: $37.41

Revised Billing Instructions and Medicaid Copayments for Telehealth Services

Effective immediately, all services delivered through telehealth whether related to delivery of a COVID19 service or any other medical service (unrelated to COVID-19) are exempt from Medicaid copayments. Medicaid copayments are applicable to hospital outpatient, free-standing clinic (including FQHCs), and emergency department services. In order to have claims paid in full with no copayment deducted, institutional providers should report Type of Admission Code = "1".


  • Medicaid FFS coverage and policy questions should be directed to the Office of Health Insurance Programs (OHIP), Division of Program Development and Management at (518) 473‑2160.
  • MMC general coverage questions should be directed to the OHIP, Division of Health Plan Contracting and Oversight at: or (518) 473‑1134.
  • MMC reimbursement, billing, and/or documentation requirement questions should be directed to the enrollee's MMC plan.
  • FFS claim questions should be directed to the eMedNY Call Center at (800) 343‑9000.

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The Medicaid Update is a monthly publication of the New York State Department of Health.

Andrew M. Cuomo
State of New York

Howard A. Zucker, M.D., J.D.
New York State Department of Health

Donna Frescatore
Medicaid Director
Office of Health Insurance Programs