Evaluation & Management (E&M) Changes
- One major update is the addition of 17 new telemedicine codes, categorized for real-time audio-video and audio-only encounters.
- These services must be provided by a physician or qualified healthcare professional (QHP).
- The CPT Code selection depends on whether the patient is new or established and whether the level of service is determined by medical decision-making (MDM) or time
Deleted Telephone CPT Code Updates
- With the introduction of new telemedicine codes, some existing codes have been deleted
- CPT – 99441, 9942 & 99443 Formerly used for telephone E/M services and G2012 Formerly used for virtual visit, these codes have been deleted to simplify telemedicine coding.
- CPT 2025 will also include new codes for audio-only telemedicine visits for new patients (98008-98011) and established patients (98012-98015)
Telephone Encounters CPT Codes
- The CPT 98016 can be billed for both Medicare & Commercial instead of CPT 99441 and or G2012 and the time must be documented minimum of 5 minutes to 10 minutes.
- If the provider spends more than 10 minutes’ appropriate codes can be used
- New patients (98008-98011)
- Established patients (98012-98015)
Telephone/Virtual Encounters CPT Codes
98016 - Brief communication technology-based service (eg, virtual check-in) by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related evaluation and management service provided within the previous 7 days nor leading to an evaluation and management service or procedure within the next 24 hours or soonest available appointment, 5-10 minutes of medical discussion
Telemedicine Services CPT Codes
- Regular E&M outpatient CPT 99202 to 99215 can be used for Medicare & Medicare HMO’s Patients, either based MDM or total time spends with the patients.
- New patients (98000-98003)
- Established patients (98004-98007)
IMPORTANT NOTE
- As per the CMS guidelines, the CPT 98008 to 98015 is not been covered by Medicare until March 31st both Telephone & Telemedicine Services.
- Modifier 93, 95 and or GT is not required for new CPT codes.
Place of Services (POS)
- POS 02 - Telehealth Provided Other than in Patient’s Home
- POS 10 - Telehealth Provided in Patient’s Home
