The 2025 CPT code set introduces new codes for synchronous audio-only and audio-video visits between patients and physicians or other qualified healthcare professionals (QHPs). These telemedicine services, which involve real-time communication between the patient and provider, are designed for non-face-to-face encounters and are used when appropriate for patient care, with the patient or their family/caregiver agreeing to this format.
Synchronous telemedicine services must meet the same criteria as in-person visits, and the benefits of delivering care via telemedicine should be documented. These new CPT codes, 98000-98015, are located in the Evaluation and Management (E/M) section of the CPT code book, following the codes for office or outpatient services (99202-99205, 99211-99215). The codes are organized as follows:
- Audio-Video Visits (CPT codes 98000-98007):
- Codes 98000-98003 are for new patients and require 15-60 minutes of total time or medical decision-making (MDM).
- Codes 98004-98007 are for established patients and require 10-40 minutes of total time or MDM.
- These codes cover MDM levels ranging from straightforward to high.
- Audio-Only Visits (CPT codes 98008-98015):
- Codes 98008-98011 are for new patients, requiring 15-60 minutes of total time or MDM.
- Codes 98012-98014 are for established patients and require 10-40 minutes of total time or MDM.
- These audio-only codes also range in MDM from straightforward to high.
- Brief Synchronous Communication (CPT code 98016):
- This code is for a brief synchronous communication (e.g., virtual check-ins) involving 5-10 minutes of medical discussion without a level of MDM.
It is important to note that these new codes cannot be used by nonphysician providers who are not authorized to report E/M codes, such as speech therapists. In such cases, refer to CPT codes 98966-98968 for telephone services provided by nonphysicians.
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Telemedicine Code Replacements and Medicare Reimbursement
The new audio-only and audio-video codes replace the previously deleted codes 99441-99443, which were used for telephone communications by physicians. Notably, Medicare will not reimburse these new codes in 2025. However, Medicare will continue to reimburse for other E/M services reported with modifiers -93 (synchronous telemedicine via telephone) or -95 (synchronous telemedicine via audio-video). These modifiers are applicable only to specific E/M codes, which can be found in Appendices P and T of the CPT code book.
At this time, the reimbursement policies of other payers regarding these new codes remain unclear, and they may continue to rely on the use of E/M codes with the -93 and -95 modifiers.
Prolonged Services
Prolonged services code +99417 may be reported if the following conditions are met:
- The service is selected based on time, not MDM.
- The code is the highest level in the category (new or established, audio-only or audio-video).
- The service lasts 15 minutes or more beyond the time indicated for the code.
For example, if a new patient’s audio-video encounter lasts 75 minutes and is selected by time, CPT code 98003 (for 60 minutes) would be reported, along with +99417 for the additional 15 minutes. If the total encounter duration exceeds 75 minutes, +99417 can be reported multiple times in 15-minute increments.
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Follow-up Visits
If a patient requires follow-up care, such as reassessment due to a complication or response to a prior treatment plan, coding will depend on the circumstances:
- If the original and subsequent visits occur on different dates, both visits can be reported.
- If the visits occur on the same date, report only the follow-up visit code and not the telemedicine code.
Exclusions for Telemedicine Coding
Certain services cannot be reported using these codes, including:
- Routine telecommunication related to prior encounters (e.g., communication of lab results).
- Asynchronous services, such as email communications (use CPT codes 99421-99423 for online digital evaluation).
- Patient oversight by clinical staff, such as chronic care management.
- Services lasting less than five minutes.
Time Counting Guidelines
For time-based selection of these codes, the time spent on the following activities should not be included:
- Chronic care management (CPT codes 99437, 99491).
- Principal care management services (CPT codes 99424, 99425).
Distinctions Between Audio-Only and Audio-Video Codes
For audio-video services (CPT codes 98000-98007), the level of service is selected based on either MDM or total time. For audio-only services (CPT codes 98008-98015), the level of service is also based on either MDM or time, but it must include at least 10 minutes of medical discussion.
“Medical discussion” refers to the time spent engaging in medical decision-making with the patient and excludes the time spent on activities such as:
- Establishing the connection.
- Arranging the appointment.
The audio-only codes do not include online digital communication, except when using synchronous telecommunication technology developed for the deaf.
Handling Connectivity Issues
In cases where the audio-video connection is lost and only audio communication is restored, report the service according to the majority of the service type—audio-only or audio-video. If the service is reported as audio-only, documentation must include at least 10 minutes of medical discussion or patient observation to meet the audio-only service requirements.
Brief Synchronous Communication (CPT code 98016)
CPT code 98016 replaces HCPCS code G2012 and is used for brief synchronous communication services. This service involves a 5-10 minute medical discussion, with the patient initiating the communication, which may be audio-only or audio-video. This code is intended to determine whether a more comprehensive visit, such as an office or other outpatient E/M service, is necessary. Medicare will reimburse for this service as it qualifies for payment under the program’s guidelines.
The requirements for “medical discussion” for this code are the same as for the audio-only and audio-video services, with exclusions for activities unrelated to direct patient care.