The ins and outs of charges for MyChart messages

While hospitals and health systems have garnered attention lately for announcing they would charge patients up to $50 for certain MyChart messages, the rule that allowed them to do so was rolled out in 2020.

The Current Procedural Terminology, or CPT, codes released that year gave providers a way to bill for patient portal messages, according to a January 2020 American Medical Association article.

Providers can bill for cumulative work done over a seven-day period that takes five minutes or more, according to the AMA report. Time worked can't be counted twice or billed under a separate code. The clock on the seven days starts ticking with the review of the patient's inquiry and can include an examination of the patient's medical record, the development of a management plan, the generation of a prescription or test order, and any subsequent online communication.

Cleveland Clinic, Evanston, Ill.-based NorthShore University HealthSystem, Chicago-based Northwestern Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, San Francisco-based UCSF Health, and Portland-based Oregon Health & Science University are among the hospitals and health systems that have recently begun charging for patient portal messages.

The announcements have drawn a mixed bag of responses. Some patients and consumer groups have criticized the action, while providers have argued that it's no different than when your lawyers charge you for answering an email.

"I've looked into it and it's more trouble than it's worth it for me," a Reddit commentator claiming to be a neuropsychiatrist wrote in November. "You can only bill it once per patient every 7 days. So if a patient sends you five messages over two weeks, you can only bill it twice. And the reimbursement is terrible, like $10-$20. Better off setting good boundaries and just ignoring messages that violate those."

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