The American Medical Association (AMA) introduced 17 new telemedicine evaluation and management (E&M) codes this year. Here’s the breakdown of these new codes: CPT® code range 98000-98007 are reported for synchronous audio-video encounters, and CPT code range 98008-98015 are reported for synchronous audio-only encounters.
There is a final code in this section, 98016, which is reported for a brief synchronous virtual check-in for established patients. The term “synchronous” means that these encounters are occurring in real time, and these services are in lieu of an in-person visit for medically appropriate care, when the patient agrees to this format for the visit.
The audio-video and audio-only sets of codes are divided into new and established patient encounters. These codes are determined based on the level of medical decision-making (MDM) or time. When using MDM, just like some of the other E&M services, there is a requirement of a medically appropriate history and/or examination, and the MDM levels are straightforward, low, moderate, and high.
The level of MDM for these codes is determined using the established E&M guidelines within the CPT book. For audio-only encounters specifically, the service must include more than 10 minutes of medical discussion, whether the level is based on MDM or time.
When time is being used to determine the level of service, there are a few guidelines to follow to help with code selection. First, it’s important to note that a telemedicine encounter of less than five minutes is not reported. The CPT code, 98016, is actually based solely on time, specifically 5-10 minutes of medical discussion with established patients only.
The audio-video and audio-only encounters are reported for encounters lasting 15 minutes or more for a new patient, and 10 minutes or more for an established patient. Each level of service has a total number of minutes that need to be met or exceeded in order to report the applicable code based on time.
The time spent establishing connection and arranging the appointment, and any time spent on online digital communication, like emails or text messaging, is not counted in the total time.
In the instance that during an audio-video encounter, the video connections are lost and the only available option is to continue the visit with audio only, report the service for which the majority of the interaction time was spent. If the majority of the time was spent on audio-only, remember that the 10 minutes of medical discussion requirement must be met.
If the total time with a new patient is 75 minutes or longer, or 55 minutes or longer with an established patient, there is a prolonged services add-on code, 99417. This code is reported in addition to the telemedicine E&M code for each additional 15-minute increment of total time.
When an audio-video or audio-only telemedicine service has been provided on the same day as an in-person E&M service, the in-person E&M code should be reported. The MDM elements or the time spent on the telemedicine visit can be counted towards determining the level of the in-person E&M service. The key to this rule is to ensure that any overlapping time and elements are not counted twice.
The area of coding and billing for telemedicine services will continue to evolve and change, and having these new telemedicine codes is a great step toward accurately reporting these types of encounters. For further information, and to get the latest updates regarding telehealth polices and billing information, visit Telehealth policy updates | Telehealth.HHS.gov.
