Insurance Reimbursement for MamaBear Check-Ins
How MamaBear’s structured, asynchronous check-ins map to billable CPT and HCPCS codes for primary care and specialist workflows.
When a parent sends structured information through a MamaBear Check-In, it supports asynchronous review (also known as store-and-forward telemedicine) by the primary care provider (PCP) and may prompt a referral to a specialist.
Primary Care Efficiency: Managing Pediatric Illness via Secure Messaging
A parent uses the MamaBear Health app to submit a Check-In for their 3-year-old, who has a low-grade fever, mild cough, and runny nose. They send a secure weblink containing the MamaBear report and video through a message in their provider’s online medical record. The clinic triage desk reviews the submission, and a provider determines that the child appears stable with no red flag signs. The family is advised to monitor at home.
Over the next 7 days, the parent continues to log symptom progression, medication responses, and nighttime disturbances in MamaBear. At 24 and 48 hours, medical messages are sent (as requested) to update the provider asynchronously. At the end of the monitoring period, the provider reviews the cumulative information and documents the clinical decision-making process.
Clinical & Operational Value
- Parents feel heard and reassured, reducing pressure for immediate visits or antibiotics
- Child is safely triaged at home without unnecessary clinic or urgent care visits
- Clinic schedules are protected from premature or low-value appointments
- Providers can review Check-Ins asynchronously during less busy times
Specialist Referrals (Store-and-Forward + Referral)
A pediatrician receives a MamaBear Check-In showing a toddler with persistent cough and wheeze. After 3 days of home monitoring, the child’s symptoms remain unchanged despite albuterol use. The provider refers the case to a pediatric pulmonologist, forwarding the MamaBear data and video via secure messaging.
The pulmonologist asynchronously reviews the symptom logs, medication response, and wheezing video. Based on the structured data and trend history, the specialist recommends an in-person visit to evaluate for asthma management and potential controller therapy.
- 99423 — Digital E/M over 7 days (21+ minutes): $60–$90
- G2010 — Asynchronous review of video/photo (e.g., wheeze video): $13–$15
- 99452 — Referral coordination and communication with the specialist: ~$37 (only billable if the consult is for a Medicare patient and qualifies under interprofessional consult codes)
PCP Total: $73–$142 per episode
If the specialist reviews the MamaBear Check-In, including data and video submitted by the PCP (not directly from the patient), they can bill:
- 99451 — Interprofessional consult via written report (5+ min): ~$37
- 99446–99449 — Interprofessional consult via verbal/phone with documentation:
- 99446: 5–10 min — ~$19
- 99447: 11–20 min — ~$37
- 99448: 21–30 min — ~$74
- 99449: 31+ min — ~$110
Specialist Total: $37–$110 per episode
- The PCP must initiate the request for specialist review.
- The specialist must not have seen the patient within the last 14 days or schedule a visit within the next 14 days (for consult codes).
- The review and decision-making must be documented in the EHR.
- MamaBear’s structured reports and asynchronous delivery help support compliance.
These codes require no face-to-face visit and support asynchronous care when documented properly.
More Information
CPT Codes for Primary Care in Asynchronous Contexts
| Code | Description | When to Use | Typical Reimbursement |
|---|---|---|---|
| G2010 | Remote evaluation of recorded video and/or images | When reviewing a MamaBear video or Check-In form to decide next steps | ~$12–$15 |
| G2012 | Brief virtual check-in (e.g., secure message or call) | When a parent-initiated message leads to a short 5–10 min discussion about whether a visit/referral is needed | ~$15–$20 |
| 99452 | Interprofessional consult — referring provider side | When sending the MamaBear Check-In (with context) to a specialist, spending ≥16 min total on prep, communication, or follow-up | ~$36–$40 |
Note: 99452 is often underused but supports asynchronous team-based care. Requires documentation of time and that the specialist provided a response.
How MamaBear Enables These Codes
- G2010 — use if you’re reviewing a submitted video or images
- G2012 — use if the parent messages or calls to decide “should I bring my child in?”
- 99452 — use if you refer based on structured data (like MamaBear Check-In) and coordinate with a specialist asynchronously
For specialist referral supported by asynchronous telemedicine (store-and-forward), these CPT codes are commonly used — particularly when a primary care provider (PCP) or a parent sends structured information (like the MamaBear Check-In) that supports a referral decision:
Referral-Related CPT Codes for Store-and-Forward Contexts
G2010 — Remote Evaluation of Recorded Video and/or Images
- Use when: a clinician evaluates pre-recorded media (like a MamaBear video, image, or Check-In form)
- Reimbursement: modest (~$12–$15), but widely accepted
- Timeframe: must provide follow-up within 24 business hours
- Good for: triage or determining if an in-person or specialist visit is needed
G2012 — Brief Communication Technology-Based Service
- Use when: a short communication (e.g., phone or secure message) is used to decide if a referral or visit is needed
- Requirement: patient-initiated, 5–10 minutes medical discussion
- Not used if the conversation leads directly into a scheduled E/M visit (within 7 days)
99452 — Interprofessional Consultation (Referring Provider Side)
- Use when: PCP sends structured data (like MamaBear Check-In) to a specialist and spends 16+ minutes preparing or following up
- Store-and-forward? Yes — this is an asynchronous consult code
- Specialist must respond, but no direct patient interaction is required
99451 — Interprofessional Consultation (Consulting Provider Side)
- Use when: a specialist reviews information without directly interacting with the patient, such as a Check-In summary or video
- Minimum time: 5 minutes of medical consult
- No direct contact with patient required
- Specialist must document their opinion in the medical record
How MamaBear Fits
| Scenario | CPT Code |
|---|---|
| MamaBear Check-In triggers specialist referral | 99452 |
| Specialist reviews Check-In before accepting referral | 99451 |
| MamaBear video is reviewed before deciding to escalate care | G2010 |
| Short message or call between PCP and family re: referral | G2012 |
Medicaid & Commercial Payers
- Rates vary by state and insurer.
- The NACHP Fall 2024 report provides state-by-state Medicaid telehealth coverage details.
- For example, New York Medicaid specifically reimburses select asynchronous codes as of January 2025.
- Some commercial plans exclude certain asynchronous codes — always verify payer-specific policy.
- RHC/FQHC facilities can use special telehealth payment rules.
What You Should Do
- Consult your Medicare Fee Schedule — payments vary by region.
- Use CCHP’s Policy Finder — offers comprehensive Medicaid telehealth policies by state.
- Check payer-specific policies, especially for Medicaid MCOs and commercial insurers.