Medical Billing
March 5, 2025
Telehealth is now a permanent part of healthcare, and CPT codes are evolving to reflect that. In January 2025, the American Medical Association (AMA) introduced CPT codes 98000–98015 to standardize billing for telemedicine evaluation and management (E/M) visits. These codes differentiate between audio-video vs. audio-only visits and apply to both new and established patients.
In this article, we’ll explain what these codes are, when to use them, how to bill them correctly, their reimbursement details, and why they matter for your practice.
These new telehealth-specific E/M codes replace older telephone visit codes (99441–99443) and provide a structured way to report virtual visits.
98000–98007 – Audio-Video Telehealth Visits
98008–98015 – Audio-Only Telehealth (Telephone) Visits
These codes mirror traditional E/M office visit codes (99202–99215) but ensure telehealth services are properly classified.
You should use CPT 98000–98015 for real-time telemedicine visits that meet the following criteria:
Audio-Video vs. Audio-Only:
New vs. Established Patients:
Medical Necessity:
Time and Complexity Requirements:
Billing Restrictions:
In practice, a good rule of thumb is: if the encounter would have merited an office visit code (99212–99215, 99202–99205, etc.) had it been face-to-face, and you provided it via telehealth instead, then a 98000-series code is likely appropriate (assuming the payer allows it).
Conversely, if the interaction is more limited or administrative, you shouldn’t use these codes. Always verify any specific payer or state telehealth criteria, but the CPT definition gives the general blueprint of when these codes apply.
Billing telehealth correctly requires careful documentation and payer verification. Here are some best practices to help avoid claim denials and ensure proper reimbursement:
Not all payers have adopted these new codes. For example, Medicare does not reimburse 98000-98015 and instead requires providers to use standard E/M codes (99202-99215) with telehealth modifiers. However, private payers and Medicaid policies vary, with some insurers covering these codes and others requiring traditional E/M billing methods.
Accurate documentation is key to support billing these codes. Providers must document whether the visit was audio-video or audio-only, the total time spent on the encounter, and the complexity of the medical decision-making (MDM).
For audio-only visits (98008–98015), documentation must specify that the discussion lasted more than 10 minutes and included meaningful medical evaluation. Without proper documentation, claims may be downcoded or denied.
Even though CPT codes 98000–98015 inherently indicate telehealth, some payers may still require modifier 95 (synchronous audio-video) or modifier 93 (synchronous audio-only) for tracking purposes.
The correct Place of Service (POS) code is also crucial. Use POS 02 (telehealth, not at home) if the patient is in a clinic or facility and POS 10 (telehealth, patient at home) if the patient is receiving care from home. Using the wrong POS code can result in reduced reimbursement.
Telehealth E/M visits must involve medical decision-making or significant evaluation. Brief administrative calls, scheduling discussions, or relaying test results should not be billed under 98000–98015. Instead, consider whether CPT 98016 (virtual check-in, 5–10 minutes) is appropriate or if the interaction is part of a broader care service that should not be billed separately.
Some payers require verbal or written patient consent for telehealth visits. Before providing a virtual E/M service, ensure the patient agrees to receive care via telehealth and document this consent in the patient’s medical record.
Many telehealth policies were expanded during the COVID-19 pandemic, but some temporary telehealth extensions, particularly those related to Medicare coverage, are currently being debated at the federal and state levels. If these policies change, it could impact which telehealth services are covered and how they must be billed. Practices should stay informed about legislative updates and adjust billing practices accordingly.
By following these tips, practices can avoid common pitfalls (like denied claims or downcoded reimbursements) when billing CPT 98000–98015. The key is to treat telehealth visits with the same rigor as office visits in coding and documentation, while staying alert to payer-specific rules for these new codes.
When it comes to reimbursement, CPT 98000–98015 present a unique situation because payers differ on whether they will pay for these codes and at what rate. Here’s what you need to know:
As telehealth continues to mature, we may see broader adoption and standard reimbursement for these services. For now, accuracy and communication with payers are key: code the service correctly, send claims, and be prepared to follow up if something doesn’t get paid as expected.
It’s also wise to educate providers that a telehealth visit is generally paid at or near the same rate as in-person by many payers – so they should put in the same level of effort and documentation, knowing it’s valued as a true billable service.
The introduction of CPT codes 98000–98015 reflects the healthcare industry's commitment to adapting to the growing demand for telemedicine services. These codes provide a standardized framework for reporting and billing telemedicine E/M services, ensuring clarity and consistency in medical records and claims processing. For healthcare practice leadership, understanding and implementing these codes is vital for optimizing telemedicine service delivery and reimbursement.
CPT 98000–98015 provide a structured way to bill telehealth visits, ensuring that audio-video and audio-only services are properly categorized. However, Medicare does not currently reimburse them, so providers should continue using standard E/M codes with telehealth modifiers for Medicare patients.
For private payers, coverage varies, so practices must verify policies before billing. Additionally, some telehealth coverage extensions remain under legislative review, meaning reimbursement policies could change in the future. Understanding and implementing these codes correctly will help healthcare organizations stay compliant, optimize telehealth reimbursement, and adapt to future policy updates.