Mastering the 2025 Telemedicine Codes: Key Insights and Best Practices for Real-Time Encounters

Basics of 2025 Telemedicine Codes

The 2025 CPT manual introduces 16 new telemedicine codes designed for real-time encounters, which are divided into those conducted via synchronous audio-video connection and audio-only connection. These codes mirror the structure of office and outpatient evaluation and management (E/M) codes. It is essential to note that the services must be provided by a physician or qualified healthcare professional (QHP), and code selection depends on whether the patient is new or established and the method used for determining the level of service, either through medical decision-making (MDM) or time spent on the encounter.

For example, CPT code 98000, the lowest level audio-video encounter for a new patient, is described as follows: “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 for code selection, a minimum of 15 minutes of service must be met or exceeded.”

It is important to note that neither the audio/video nor the audio-only code sets include an equivalent to the nurse visit (code 99211).

For encounters that do not occur in real time, such as email exchanges, the appropriate online E/M codes (99421-99423) should be used. Additionally, for established Medicare patients, the remote evaluation of recorded video or images (G2010) remains an option.

Place of service (POS) codes will continue to have two telehealth designations:

• 02 Patient not in their home when telehealth services are rendered;
  

Descriptor: The location where health services and health related services are provided or received, through telecommunication technology. Patient is not located in their home when receiving health services or health related services through telecommunication technology

• 10 Patient in their home when telehealth services are rendered. POS 10 will continue to be paid at the non-facility rate.

Descriptor: The location where health services and health related services are provided or received through telecommunication technology. Patient is located in their home (which is a location other than a hospital or other facility where the patient receives care in a private residence) when receiving health services or health related services through telecommunication technology.

Key Tips for Telemedicine E/M Services

1. Ensure HIPAA Compliance: All audio and video encounters must take place on a HIPAA-secure platform. Audio-only encounters can be conducted over a regular phone line, provided the call is not recorded.
2. Obtain and Document Patient Consent: Always obtain consent from the patient or their caregiver before each telemedicine session. This consent should be documented, and patients should be informed of any copays associated with the service.
3. Document the Type of Connection: Providers should document whether the session was conducted via audio-video or audio-only. Coders cannot assume the type of connection, and there is no default code if this information is not provided.
4. Track Time for All Encounters: Keep accurate time logs for each encounter. If an audio-video encounter transitions to audio-only due to technical issues, report the service that accounts for the majority of the time spent during the interactive portion. For an audio-only encounter, medical discussion must exceed 10 minutes.
5. No Frequency Limits: Multiple E/M encounters can be reported for the same patient within a week. However, they cannot be reported on the same date as another E/M service, whether in-person or via telemedicine.
6. Add Time for Same-Day Encounters: If a telemedicine encounter takes place on the same day as an in-person encounter, combine the total time for both services. Ensure that time is not double-counted, and select the appropriate code based on the total time spent.

FAQ

1. What is the difference between the new audio-video and audio-only telemedicine codes?
   Audio-video encounters require a visual connection, whereas audio-only encounters are conducted via voice communication alone. Both types of encounters are coded separately based on the type of connection used.
2. What should be documented for each telemedicine encounter?
   Providers must document the type of connection (audio-video or audio-only), obtain patient consent for the service, and track the time spent during the encounter.
3. Can multiple telemedicine E/M encounters be reported for the same patient in a week?
   Yes, multiple telemedicine E/M encounters can be reported for the same patient within a week, but they must not occur on the same date as another E/M service.
4. What should be done if an audio-video encounter becomes an audio-only encounter due to technical difficulties?
   If an audio-video encounter becomes audio-only, the service that accounts for the majority of the time during the interactive portion should be reported. If the encounter is primarily audio-only, medical discussion must exceed 10 minutes.
5. How should time be documented for telemedicine encounters on the same day as in-person visits?
   The total time for both the telemedicine and in-person encounters can be added together, but ensure there is no double-counting. Select the appropriate code based on the total time spent across both encounters.