The American Medical Association CPT Editorial Panel established 17 telemedicine codes. These evaluation and management (E/M) codes correspond with the time spent with a patient, the level of medical decision-making (MDM), whether a patient is new (98000 – 98003; 98008 – 98011) or established (98004 – 98007; 98012 – 98015), and whether the practitioner used both audio and video (98000 – 98007) or audio-only (98008 – 98015). The CPT Editorial Panel also deleted three codes (99441-99443) for reporting telephone E/M services.
Medicare will not reimburse most new codes. Practitioners should not bill Medicare using CPT codes 98000 – 98015. CMS has determined that it will not provide reimbursements for 98000 – 98015 because the codes are, in effect, duplicative of existing codes with appropriate modifiers. However, because 98016 is completely replacing G2012, CMS will reimburse 98016.
While Medicare will not provide reimbursement for 98000 – 98015, CMS has nonetheless assigned payment rates under the Medicare Physician Fee Schedule. Notably, the reimbursement rates assigned to these codes by CMS are lower than their in-person office visit counterparts.
To determine whether other payers will use CPT codes 98000 – 98015 (and if so, at what reimbursement rate), allergists should directly reach out to individual carriers.
Audio-video – new patient
- 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 75 minutes or longer, use prolonged services code 99417.)
Audio-video – established patient
- 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 – Synchronous audio-video visit for the evaluation and management of an established 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, 20 minutes must be met or exceeded.
- 98006 – Synchronous audio-video visit for the evaluation and management of an established 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, 30 minutes must be met or exceeded.
- 98007 – Synchronous audio-video visit for the evaluation and management of an established 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, 40 minutes must be met or exceeded.
Audio-only – new patient
- 98008 – Synchronous audio-only visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination, straightforward medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded.
- 98009 – Synchronous audio-only visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination, low medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
- 98010 – Synchronous audio-only visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination, moderate medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.
- 98011 – Synchronous audio-only visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination, high medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded. (For services 75 minutes or longer, use prolonged services code 99417.)
Audio-only – established patient
- 98012 – Synchronous audio-only visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination, straightforward medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 10 minutes must be exceeded.
- 98013 – Synchronous audio-only visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination, low medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.
- 98014 – Synchronous audio-only visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination, moderate medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
- 98015 – Synchronous audio-only visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination, high medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded. (For services 55 minutes or longer, use prolonged services code 99417.)
Virtual check-in
- 98016 – Brief communication technology-based service (e.g., 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 seven 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.
As outlined above, CPT Code 98016 replaces HCPCS Code G2012 for virtual check-ins. Practitioners should only report 98016 if a patient initiates a call that includes 5-10 minutes of medical discussion. The discussion must not be related to an E/M visit that occurred in the last seven days, nor can the discussion lead to an E/M service in the 24 hours following the check-in call.
The Advocacy Council – ADVOCATING FOR ALLERGISTS AND THEIR PATIENTS.
