Should patients have to pay for messaging their doctors online?

By Samar Mahmoud, PhD | Medically reviewed by Kristen Fuller, MD
Published May 11, 2023

Key Takeaways

  • Healthcare systems have recently started billing patients for online messages between a doctor and their patient.

  • Providers can bill for patient-initiated messages with established patients if a virtual assessment is conducted and the provider develops a management plan for the patient’s condition. 

  • Healthcare professionals can stay abreast of message billing rates and provide insight into what messages are eligible for billing.

The COVID-19 pandemic has revolutionized how healthcare providers communicate with their patients, leading to an increase in telehealth visits and the use of online communication tools. However, while increased patient communication with healthcare providers is positive, it also means that providers spend more time responding to messages and providing medical advice. 

Healthcare systems have recently started charging for the time providers take to do this, with some hospitals announcing they would charge patients up to $50 for MyChart Messages.[]  

Changes to CPT codes 

The rule that allows healthcare systems to charge for messages was actually released as part of the 2020 Current Procedural Terminology (CPT) codes.[] The 2020 CPT codes include three, new time-based codes that allow providers to bill for time spent responding to patient-initiated messages over a 7-day period. 

What services are not billable? 

Providers cannot use the codes to bill patients for work that takes less than five minutes, according to the Cleveland Clinic, and any time worked cannot be counted twice.[]

Other examples of patient services that will not incur a fee include:

  • Prescription refill requests

  • Appointment requests 

  • Messages that end in a provider recommending the patient schedule a visit

  • Communication that was preceded by a visit for the same issue in the prior 7 days

  • Communication that leads to an appointment for the same issue in the following 7 days

  • Follow-up care that is related to a surgery that took place within the previous 90 days

What services can providers bill for? 

The Cleveland Clinic, which started charging for MyChart messages in November of 2022, has indicated that billing for MyChart communications will range from $33 to $50 depending on the communication. 

Patients can expect messages that “require a provider to make a clinical assessment or medical decisions, order a test or medication, or review medical history in order to respond to the patient” are eligible for billing.

In order to charge for MyChart messages, the following must be true:[] 

  • The patient must have an established relationship with the healthcare provider 

  • The patient has to initiate the message 

  • Communication between patient and provider has to include a virtual assessment as well as development of a management plan 

  • The dialogue can take place over a 7-day period

Cost of billable messages 

According to UCSF Health, which began charging for messages on November 14, 2021, most patients will not incur any costs when using MyChart messages.[]

However, for patients who will have out-of-pocket expenses for patient-initiated inquiries, UCSF health expects the following costs, dependent on the type of insurance plan: 

  • Medicare: For the majority of patients, there will be no out-of-pocket cost. For some patients, the cost will be minimal, ranging from $3 to $6. For patients with Medicare Advantage, certain MyChart communications will cost the same as an in-person or telehealth visit. 

  • Medi-Cal: There will be no out-of-pocket costs for patients. 

  • Private insurance: Some patients will have co-pays that will be similarly priced to an in-person or telehealth visit. If a patient has a deductible, the full amount will be charged, with the average cost around $75. 

What this means for you 

Many healthcare systems are starting to charge for certain features of MyChart messages, recognizing that providers spend time and share their expertise when responding to a patient inquiry. However, it is important that providers be transparent with patients about which inquiries are billable and which are not. Similarly, providers should discuss with patients which scenarios warrant an in-person visit and which can be answered via a MyChart message.

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