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Patient portal communication with a physician that is initiated by the patient and requires significant physician review, evaluation and response is a valuable professional service that helps patients improve or maintain their health between visits. Such communications can require significant physician time and effort and therefore may generate a portal telemedicine charge. Simple prescription refill requests and other administrative matters will not generate a telemedicine charge. Matters requiring a telephone call from the physician to the patient are also recognized as a physician service by Medicare and some other insurers and may generate a phone telemedicine charge.

Possible levels for portal telemedicine visits per Medicare guidelines are CPT codes 99421 for 5-10 minutes over 7 days, 99422 for 10-20 minutes over 7 days, 99423 for 21 or more minutes over 7 days. Medicare also recognizes telephone visits, CPT codes 99441 (5-10 minutes), 99442 (11-20 minutes), and 99443 (21-30 minutes). Medicare recognizes and covers these telemedicine or telephone visit service codes. Like other covered services, they might generate a patient co-payment responsibility.  Coverage policies of other insurance companies vary for telemedicine portal and phone visits.