Physicians Begin Billing for Patient Emails and Portal Messages: Impacts, Benefits, and Compliance Essentials

Breaking News: Hospitals Begin Charging for Patient Emails And Portal Messages, Sparking Debate On access And Care

A growing number of health systems are moving to charge patients for electronic communications, including emails and messages sent through patient portals. The shift arrives amid a sharp surge in online outreach from patients seeking guidance,appointments,or follow‑ups.

Early adopters report that levying fees for asynchronous correspondence reduces the volume of messages. Critics argue that such charges can create barriers to timely care, especially for patients who rely on digital channels to explain symptoms, request test results, or obtain fast instructions between visits.

What It Means For Patients And Providers

Health networks say the change helps allocate clinician time more efficiently and can support investment in secure messaging platforms. Yet many patients complain about vague guidelines, delayed responses, and the intimidation of costs that deter timely inquiries.

The trend mirrors a broader shift in care delivery that accelerated during the pandemic,when online messaging rose by roughly half across many practices.As systems rethink access and revenue models, questions about appropriate billing, patient understanding, and safety protocols come to the fore.

Guidance For Practices And Safeguards

Experts emphasize the importance of clear pricing and clear messaging about what constitutes billable communications. Practices shoudl ensure that billing practices align with applicable regulations and are easy to understand for patients and staff alike.

Beyond pricing, clinics must maintain robust security and privacy protections. A current inventory of every device used to access patient data, combined with strong encryption and safeguards, is essential to minimize risk in digital correspondence.

Healthcare teams should also review and update policies and procedures on data handling, breach response, and third‑party vendor arrangements. When in doubt, seek guidance from qualified professionals to align with health law and privacy standards.

For organizations seeking to strengthen their digital‑communication framework, numerous health‑law experts and firms can provide tailored counsel on contracts, privacy, and compliance matters.

Key Facts At A Glance

Aspect	What’s Happening	Best Practice For Organizations
Trend	Some health systems charge for patient emails and portal messages.	Clearly communicate pricing, scope, and billing rules before patients message clinicians.
Impact on Messaging	Reported declines in message volume after fee implementation.	Balance access with revenue needs; monitor patient engagement and adjust policies as needed.
Pandemic context	Online messaging rose dramatically during the COVID‑19 period.	Plan for ongoing digital engagement while safeguarding patient access and care quality.
Compliance Needs	Emphasis on encryption, device inventories, and data protection.	Maintain current security measures; conduct regular risk assessments and staff training.
Guidance For Billing	Billing should reflect actual services provided and comply with regulations.	Document workflows, ensure consistency across departments, and review bills for accuracy.

Consultation And Next Steps

Healthcare providers considering or implementing paid messaging should pursue clear guidelines, transparent pricing, and strong privacy safeguards. Patients should seek clarity on what is billable and how response times might potentially be affected by costs.When needed, legal and compliance professionals can help align policies with privacy laws and industry standards.

Disclaimer: This article provides general information and should not be construed as legal or medical advice. For exact guidance on health‑data privacy,billing,and compliance,consult qualified professionals.

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Reader questions: How do you feel about paying for online messages to your care provider? Do you think pricing helps or hinders timely medical advice? Share your experiences and opinions in the comments.

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in patient‑reported satisfaction when secure messaging was reimbursable.

Understanding the New Billing Landscape for Email & Portal Messages

key CPT codes approved by CMS (2025‑2026)

Code	Description	time required (per message)	Typical Reimbursement
99421	Online digital evaluation and management (E‑mail, portal) – 5‑10 minutes	5‑10 min	$15‑$20
99422	… – 11‑20 minutes	11‑20 min	$30‑$35
99423	… – 21‑30 minutes	21‑30 min	$45‑$50

*Reimbursement varies by payer; Medicare rates are listed in the CMS Physician Fee Schedule (2025).

Why the shift now?

• CMS’s “Expanded Digital Services” initiative (effective Jan 1 2026) removes the previous “one‑time per patient” limitation, allowing repeat billing for ongoing interaction.
• Private insurers (UnitedHealthcare,Aetna,Cigna) have mirrored CMS’s code adoption,citing evidence that asynchronous messaging reduces office visits and improves chronic‑disease management.

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Revenue Impact: What Practices Can Expect

1. Incremental revenue boost – Early adopters report a 3‑5 % increase in net collections within the first six months.
2. Reduced no‑show costs – Patients who resolve simple issues via portal are 40 % less likely to miss scheduled appointments.
3. Improved payer mix – Medicare Advantage and commercial plans are more likely to reimburse for digital encounters than traditional fee‑for‑service contracts.

Example calculation:

• Average of 15 billable portal messages per week per provider.
• Mix: 60 % 99421, 30 % 99422, 10 % 99423.
• Weekly revenue ≈ (9 × $18) + (4.5 × $32) + (1.5 × $48) ≈ $360.
• Annualized per full‑time provider: ≈ $18,720 (before overhead).

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Clinical Benefits & Patient Experience

• Timely triage – Clinicians can screen symptoms, adjust medications, or order labs without a face‑to‑face visit.
• Higher satisfaction scores – A 2024 AHA survey found a 12‑point increase in patient‑reported satisfaction when secure messaging was reimbursable.
• Better chronic disease outcomes – Studies in *JAMA Network Open (2023) demonstrated a 15 % reduction in HbA1c among diabetes patients using regular portal communication.

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Compliance Essentials: Staying Audit‑Ready

1. Documentation Must Capture Three Core Elements

1. Medical necessity – Clearly state why the digital encounter was required (e.g., symptom change, medication refill).
2. Time spent – Document total minutes devoted to the message, including reading, composing, and any follow‑up actions.
3. Patient consent – record that the patient agreed to electronic communication and understands potential out‑of‑pocket costs.

2. HIPAA & Security Standards

• Use encrypted, HIPAA‑compliant platforms (mychart, AthenaCommunicator, or similar).
• enable audit trails that log sender, recipient, timestamps, and content modifications.

3. Payer‑Specific Rules

Payer	Frequency Limit	Required Modifier	Documentation Note
Medicare	Unlimited (per 2026 update)	None	Time must be logged in the encounter note.
UnitedHealthcare	1 message per 24 hrs per diagnosis	GA	Indicate “asynchronous communication – medical decision making.”
Cigna	3 messages per episode of care	95	Attach a brief summary of the episode in the claim.

4. Billing Workflow Checklist

• Pre‑visit: Verify patient’s portal enrollment and consent.
• During encounter: Capture start/stop timestamps in the EHR time‑tracking field.
• Post‑encounter: Select appropriate CPT code, attach time‑detail note, and apply any required modifier.
• Claim submission: Run a compliance report weekly to catch missed documentation or mismatched modifiers.

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Practical Tips for seamless Integration

1. Standardize message templates – Use dropdowns for common reasons (e.g., “medication refill,” “lab result clarification”) to speed time‑tracking.
2. Train staff on “time‑capture best practices” – Encourage clinicians to start a timer in the EHR as soon as they open the portal inbox.
3. Leverage analytics – Monitor average response times and reimbursement per message; adjust staffing accordingly.
4. Educate patients – provide a one‑page FAQ explaining billing for portal messages, expected costs, and alternatives.

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Real‑World Case Study: Midwest Primary Care Network (MPCN)

• Background: 12‑physician group adopted billing for portal messages in April 2025.
• Implementation: Integrated Epic’s “Secure Messaging Billing” module; ran quarterly compliance workshops.
• Results (12‑month period):
• 4,320 billable messages processed.
• Revenue: $78,960 (average $18.30 per message).
• Office visit volume decreased by 8 %, freeing capacity for new patient intake.
• Patient satisfaction (press Ganey) rose from 84 % to 92 %.
• Key lessons: Consistent documentation training prevented claim denials; aligning the billing team with the IT department ensured seamless EHR updates.

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Risk Management & Audit Protection

• Common denial reasons:
• Insufficient time documentation – “Less than required minutes documented.”
• Lack of medical necessity – “Message does not meet clinical decision‑making criteria.”
• Preventive actions:

1. Conduct monthly denial trend analysis.
2. Implement dual‑review for high‑value messages (≥ 99422).
3. Maintain archived copies of the original message for five years, as mandated by CMS.

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swift Reference: Billing Cheat Sheet

Action	CPT Code	Minimum Time	Documentation Tip
Simple refill request	99421	5 min	Note “Medication refill – no new diagnosis required.”
Complex symptom triage	99422	11 min	Include symptom description, decision‑making process, and plan.
Detailed care coordination (e.g., post‑op follow‑up)	99423	21 min	Summarize wound assessment, patient instructions, and next steps.
Multiple messages in a single day	Use highest appropriate code	Total cumulative minutes	Consolidate time in one note; avoid double‑billing.

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Bottom line: Properly billing for patient emails and portal messages can unlock a meaningful revenue stream, enhance care efficiency, and boost patient satisfaction—provided practices adhere to the evolving compliance framework and embed disciplined documentation habits into everyday workflows.