The COVID-19 pandemic significantly affected the healthcare industry in myriad ways, including communication methods between patients and their physicians. In particular, the frequency of telehealth visits during and following the height of the pandemic has skyrocketed, and with it, the use of online communication in physician-patient relationships. Whereas more frequent online communication has positive implications overall, it does require physicians to devote a larger amount of time responding to patients’ inquiries.

As such, several healthcare systems have begun charging patients for the time that providers devote to online communication, with some hospitals requiring payment of up to $50 for exchanging messages in the MyChart platform. According to the American Medical Association, healthcare systems were afforded the right to demand payment due to a rule released as part of the 2020 Current Procedural Terminology codes. Specifically, three new time-based codes permit physicians to charge patients for time devoted to patient-initiated messages during a 7-day timeframe.

However, not all services are billable. For instance, the Cleveland Clinic notes that it is not permissible for physicians to bill patients under these codes for work that requires less than 5 minutes. Providers are also prohibited from attempting to seek payment by double-counting work. Additional online communication services that do not require patient payment include requests for appointments and prescription refills, messages culminating in a physician-suggested scheduled visit, patient inquiries regarding a visit within 7 days prior, and inquiries pertaining to surgery that occurred within 90 days prior.

As of November 2022, the Cleveland Clinic began charging a fee for MyChart communications, ranging from $33 to $50. According to nurse practitioner Amy Isler, RN, MSN, CSN, online messages are billable if they involve patients requesting that physicians make clinical assessments or medical decisions. Other billable online communications include requests for tests or inquiries that require a physician to review the patient’s medical history, she says. For a physician to request payment for online services, the patient must have an established relationship with the healthcare provider. Isler adds that the patient must initiate contact and that communication regarding the message must be able to take place over a 7-day timeframe. Additionally, patient-physician communication must include a virtual assessment in tandem with a well-developed management plan.