Basics of CPT Code 98000, 98001, 98002, 98003

We have entered into 2025 and we have many new CPT codes to use in this year. Synchronous audio-video visit codes are added this year and are based on New and Established patient. Also the time plays an important factor to choose the correct CPT code. Below I am sharing the description of the New CPT 98000, 98001, 98002 & 98003.

98000 Synchronous audio-video visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making.

When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded.

98001 Synchronous audio-video visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low medical decision making.

When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.

98002 Synchronous audio-video visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate medical decision making.

When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.

98003 Synchronous audio-video visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high medical decision making.

When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.

For services 55 minutes or longer, use prolonged services code 99417

How to choose correct CPT Code 98000, 98001, 98002, 98003

Providers should use these codes for new patient visits conducted via telehealth using synchronous audio-video communication as an alternative to in-person consultations. During these encounters, the provider and patient engage from separate locations through real-time, interactive communication, allowing them to see and hear one another. A medically appropriate history and/or examination are required for all encounters. The correct CPT code selection is determined by the level of medical decision making (MDM) or the total time spent by the physician or other qualified healthcare professional(s) on the date of the encounter.

MDM factors to consider include the number and complexity of problems addressed, the amount and complexity of data reviewed and analyzed, and the potential risks of complications, morbidity, or mortality associated with patient management. CPT code 98000 represents the most basic service, involving straightforward MDM. If time is used as the basis for code selection, the total time must meet or exceed 15 minutes on the day of the encounter.

CPT code 98001 should be reported for visits requiring a low level of MDM or for those that involve at least 30 minutes of total time. Use CPT code 98002 for visits with moderate MDM or those requiring at least 45 minutes of total time. Finally, CPT code 98003 is appropriate for encounters involving high-level MDM or those that exceed 60 minutes of total time.

When to use Prolonged services CPT code 99417

99417 – Prolonged outpatient evaluation and management service(s) time with or without direct patient contact beyond the required time of the primary service when the primary service level has been selected using total time, each 15 minutes of total time (List separately in addition to the code of the outpatient Evaluation and Management service)

The Prolonged services codes are assigned only when the code for the primary E/M service has been selected based solely on total time, and only after exceeding the required time to report the highest-level of service by at least 15 minutes

CPT code +99417 is an addon code and should be always used with a primary code. Here, code 99417 should be used only with CPT code 98003, as primary code. Since more than 55 minutes we have to use prolonged services codes, so for more than 55 minutes we have use code 99417 to report extra time.

Always remember, Do not report 99417 for any time unit less than 15 minutes

CPT code 99417 would not be reported with code 98003, until at least 15 minutes of time beyond 55 minutes has been accumulated (70 minutes) on the day of the encounter