The 2025 expansion of CPT (Current Procedural Terminology) codes is poised to bring significant changes to primary care practices, with the introduction of 270 new codes, 38 revisions, and 112 deletions. These updates, effective January 1, 2025, are crucial for providers to review in advance to ensure timely reimbursement.
On September 1, the American Medical Association unveiled the 2025 CPT code set, offering a comprehensive preview for practices to prepare. While many coders are still awaiting their official CPT 2025 manuals, the changes are available through the minutes of recent CPT Editorial Committee meetings. Here are the key updates that primary care practices should be aware of:
1. Introduction of 17 New Telemedicine Codes
In response to the rapid shift toward telehealth during the pandemic, the CPT Editorial Committee has introduced a new section dedicated to telemedicine. This includes 17 new codes for audio-video consultations, both for new and established patients.
For new patients, the following codes apply:
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 – …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 – …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 – 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 established patients, the new codes are:
98004 – Synchronous audio-video visit for the evaluation and management of an established 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, 10 minutes must be met or exceeded.
98005 – … 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, 20 minutes must be met or exceeded
98006 – …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, 30 minutes must be met or exceeded
98007 – … 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, 40 minutes must be met or exceeded
Additionally, new codes will replace existing telephone-only codes (99441-99443), providing expanded options for reporting audio-only telemedicine visits. These changes reflect the growing need for specialized telehealth billing practices. However, it remains unclear whether Medicare will reimburse these services, as the Proposed 2025 Medicare Physician Fee Schedule suggests no immediate need for these specific telemedicine codes.
A new code 98016 will replace HCPCS code G2012 for brief virtual check-ins, which involves a 5-10 minute discussion with an established patient.
2. Changes to Vaccine Codes
Several vaccine codes will also be updated in 2025, including the addition of:
- 90684: Pneumococcal conjugate vaccine, 21-valent (PCV21)
- 90695: Influenza virus vaccine, H5N8, derived from cell cultures, adjuvanted, for intramuscular use
Starting January 1, there will be important updates to several vaccination codes. For example, the descriptor for code 90661 will be revised to more accurately reflect the vaccine’s composition: “Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, antibiotic-free, 0.5 mL dosage, for intramuscular use.” This change ensures greater clarity and precision in coding, helping providers avoid any confusion and streamline the billing process.
These changes will be reflected in the CPT 2025 manual and impact how vaccine-related services are coded.
3. Refinement of Remote Therapeutic Monitoring (RTM) Codes
To increase specificity in remote therapeutic monitoring services, several changes are being introduced. These include updated descriptors for codes related to:
98975: Remote therapeutic monitoring (eg, therapy adherence, therapy response); initial set-up and patient education on use of equipment In 2025, this descriptor will add a mention of digital therapeutic intervention.
98976: Remote therapeutic monitoring (eg, therapy adherence, therapy response); device(s) supply with scheduled (eg, daily) recording(s) and/or programmed alert(s) transmission to monitor respiratory system, each 30 days In 2025, this descriptor will add a mention of device supply for data access or data transmissions to support RTM.
98977: Remote therapeutic monitoring (eg, therapy adherence, therapy response); device(s) supply with scheduled (eg, daily) recording(s) and/or programmed alert(s) transmission to monitor musculoskeletal system, each 30 days In 2025, this descriptor will add a mention of device supply for data access or data transmissions to support RTM.
98978: Remote therapeutic monitoring (eg, therapy adherence, therapy response); device(s) supply with scheduled (eg, daily) recording(s) and/or programmed alert(s) transmission to monitor cognitive behavioral therapy, each 30 days In 2025, this descriptor will add a mention of device supply for data access or data transmissions to support RTM.
These services are designed to track the efficacy of ongoing treatments through remote patient data and will now be more precisely defined in terms of device usage and data transmissions.
4. Category III Codes for Artificial Intelligence in Medicine
CPT 2025 will introduce seven new Category III codes designed to describe the use of artificial intelligence (AI) in augmentative data analysis. These codes are intended to address advanced technological applications in several medical fields. Specifically, the new codes will apply to medical chest imaging (codes 0877T-0880T), electrocardiogram measurements (codes 0902T-0932T), and image-guided prostate biopsies (codes 0898T).
Category III codes are assigned to emerging technologies that are in the early stages of development or adoption, and they are generally considered temporary. As these technologies mature and demonstrate broader clinical utility, there is potential for them to be reclassified as permanent Category I codes. If this occurs, the existing Category III codes will be replaced by the more widely accepted Category I codes, which are used for established practices in medicine. This process allows for ongoing evaluation and integration of cutting-edge advancements into clinical practice.
The 2025 CPT code changes offer an exciting opportunity for primary care practices to expand their services, especially in the realm of telemedicine. However, it’s important to familiarize yourself with these updates ahead of the January 1 implementation date to ensure that your practice can seamlessly navigate the new coding landscape and maintain financial flow. Stay informed on how these changes impact reimbursement policies, particularly for Medicare, and be proactive in updating your billing processes accordingly.
Any update on if the Telemedicine codes will ACTUALLY be put into use yet?
all the new telemedicine codes will be used from 1st january 2025