01/18/2025
New Telemedicine Codes (2025)
Last Updated January 08, 2025
CPT® has added 17 new codes for telemedicine evaluation and management (E/M) services. Telephone E/M codes 99441-99443, will be deleted. There are three new code categories:
Synchronous Audio-Video E/M Services
Synchronous Audio-Only E/M Services
Brief Synchronous Communication Technology Service (eg, Virtual Check-In)
*Prior to using these codes, please verify payer policies as not all payers are adopting the new codes.
Guidelines:
Telemedicine services are synchronous, real-time, interactive encounters.
For asynchronous services (ie, not live in real-time), see Online Digital Evaluation and Management Services (99421, 99422, 99423).
Do not use telemedicine services to report routine telecommunications related to a previous encounter (eg, to communicate laboratory results).
Telemedicine services may be used for follow-up of a previous encounter, when a follow-up E/M service is required, in the same manner as in-person E/M services are used.
For example, a patient requiring re-assessment for response or complications related to the treatment plan of a previous visit.
Except for 98016, these services do not require a specific time interval from the last in-person or telemedicine visit and may be initiated by a physician or other QHP as well as by a patient and/or family/caregiver.
Telemedicine services must be performed on a separate calendar date from another E/M service.
If during the encounter, audio-video connections are lost and only audio is restored, report the service that accounted for the majority of the time of the interactive portion of the service.
Synchronous Audio/Video
You will determine the appropriate service level for the codes in the same way you do for the office/outpatient E/M service codes 99202-99215, either by the level of medical decision making (MDM) or by calculating the total physician/QHP time for the service on the date of the encounter. Both the MDM level and total service times for 98000-98007 parallel the levels for 99202-99215.
Audio/Video New Patient Codes - synchronous audio-video visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination.
Code level chosen based on MDM complexity or time.
Code
MDM Complexity
Time Requirement
98000
Straightforward
15+ minutes
98001
Low
30+ minutes
98002
Moderate
45+ minutes
98003
High
60+ minutes
Audio/Video Established Patient Codes - synchronous audio-video visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination.
Code level chosen based on MDM complexity or time.
Code
MDM Complexity
Time Requirement
98004
Straightforward
10+ minutes
98005
Low
20+ minutes
98006
Moderate
30+ minutes
98007
High
40+ minutes
Audio-only
MDM levels & time requirements for these codes are also the same as the office/ outpatient and synchronous audio/video E/M codes.
These codes require more than 10 minutes of medical discussion. For services of 5 to 10 minutes of medical discussion, report 98016, if appropriate.
Audio Only New Patient Codes - Synchronous audio-only visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and more than 10 minutes of medical discussion.
Code level chosen based on MDM complexity or time.
Code
MDM Complexity
Time Requirement
98008
Straightforward
15+ minutes
98009
Low
30+ minutes
98010
Moderate
45+ minutes
98011
High
60+ minutes
Audio Only Established Patient Codes - Synchronous audio-only visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and more than 10 minutes of medical discussion.
Code level chosen based on MDM complexity or time.
Code
MDM Complexity
Time Requirement
98012
Straightforward
10+ minutes
98013
Low
20+ minutes
98014
Moderate
30+ minutes
98015
High
40+ minutes
Virtual Check-In
Code 98016 is for brief communication technology-based service (eg, virtual check-in) by a physician or other qualified health care professional who can report E/M services, provided to an established patient, not originating from a related E/M service provided within the previous 7 days nor leading to anE/M service or procedure within the next 24 hours or soonest available appointment, 5-10 minutes of medical discussion.
The service is patient-initiated and intended to evaluate whether a more extensive visit type is required.
Do not count time for establishing the connection or arranging the appointment, even when performed by the physician or other QHP.
Services of less than five minutes are not reported.
When the check-in leads to an E/M service on the same calendar date, and when time is used to select the level of that E/M service, the time from 98016 may be added to the time of the E/M service for total time on the date of the encounter.
This code will replace HCPCS code G2012 for Medicare
Medicare
Under the current statute, the geographic location and site of service restrictions on Medicare telehealth services will once again take effect for services furnished beginning April 1, 2025. Although there are some important exceptions, including for behavioral health services and ESRD-related clinical assessments, most Medicare telehealth services will once again, in general, be available only to beneficiaries in rural areas and only when the patient is located in certain types of medical settings.
Even if congress acts to extend the geographic location and site waivers, CMS will not recognize these new codes for telemedicine services provided to Medicare patients. For Medicare patients, this means that physicians will need to continue to report the same codes as for in-person office visits and use appropriate POS codes and modifiers.
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