CPT 98000–98015: How to Bill and Get Reimbursed for Telehealth Services

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. 

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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.

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What are CPT Codes 98000–98015?

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

• Used for real-time video consultations between a provider and patient.
• Categorized by patient status (new vs. established) and MDM complexity or total time spent.

98008–98015 – Audio-Only Telehealth (Telephone) Visits

• Used when a video connection is unavailable or impractical.
• Requires at least 10 minutes of medical discussion to be billable.
• Also categorized by new vs. established patient status and complexity/time.

These codes mirror traditional E/M office visit codes (99202–99215) but ensure telehealth services are properly classified.

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When Can You Use These Codes?

You should use CPT 98000–98015 for real-time telemedicine visits that meet the following criteria:

Audio-Video vs. Audio-Only:

• Use 98000–98007 when both audio and video are used.
• Use 98008–98015 if the visit is telephone-only.

New vs. Established Patients:

• New patient visits require longer durations and documentation of a full E/M service.

Medical Necessity:

• The visit must include a medically appropriate history/exam and decision-making.

Time and Complexity Requirements:

• Code selection is based on MDM level or total time spent on the encounter.
• For audio-only visits, documentation must show >10 minutes of discussion.

Billing Restrictions:

• These codes cannot be billed if an in-person visit follows within 24 hours or if the service is part of a procedure’s global period.

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.

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Tips for Billing CPT 98000-98015

Billing telehealth correctly requires careful documentation and payer verification. Here are some best practices to help avoid claim denials and ensure proper reimbursement:

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Check Payer Policies Before Billing 

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.

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Document Thoroughly

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.

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Use Proper Modifiers & Place of Service (POS) Codes

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.

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Don’t Bill These Codes for Routine Calls

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.

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Confirm Telehealth Consent Requirements

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.

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Monitor Reimbursement Trends and Legislative Changes

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.

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Fees and Reimbursement

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:

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Medicare

• Medicare (CMS) has explicitly decided not to adopt 98000–98015 for payment in 2025. In the Medicare Physician Fee Schedule final rule, CMS assigned these 16 codes a status indicator of “I” – meaning “Not valid for Medicare purposes; use another code.” 
• In practice, CMS is telling providers to keep using the regular office/outpatient E/M codes for telehealth visits (which Medicare has temporarily allowed as telehealth services) rather than these new telehealth-specific codes​. The rationale is that 98000–98015 don’t give Medicare anything they can’t already handle with existing codes plus telehealth modifiers, so they saw “no programmatic need” to recognize them​. 
• As a result, if you bill Medicare 98000–98015, you’ll get no payment – those claims will be rejected or denied. 
• Instead, for Medicare telehealth visits in 2025, use 99202–99215 with the modifiers/POS as discussed. 
• One exception: CPT 98016 is adopted by Medicare, as it directly replaces HCPCS code G2012 (the virtual check-in). CMS finalized payment for 98016 and even set its work RVU (0.30) to mirror G2012​. But for the primary visit codes 98000–98015, Medicare will ignore them.

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Private Payers & Medicaid

• Coverage varies by insurance plan, so some payers may choose to recognize these new codes, while others still require traditional E/M codes and telehealth modifiers.
• The AMA created these codes in hopes of standardizing telehealth reporting, so there is an expectation that many private payers will start accepting them (especially as the old phone codes were deleted). 
• Some large national insurers have indicated they will align with AMA coding, but each payer sets its own policy and fee schedule. Practices should reach out to their major payers to confirm: whether CPT 98000-98015 will be accepted for telehealth E/M services, the payment rate, and if these codes will not be accepted—how telehealth visits should be billed.
• If a payer does cover these codes, make sure your practice management system or billing software has the updated CPT fee schedule with 98000–98015 added. Assign your usual charges to them (perhaps mirroring similar office visit charges). Be aware that some payers might temporarily assign them a status of “manual review” or delay payments early in 2025 as everyone adjusts – keep an eye on your Accounts Receivable for telehealth claims to catch any issues.
• For practice owners, the big picture is that if a payer reimburses these codes, the payment should be in the same ballpark as an office visit, not drastically different.
• Telehealth visits coded with 98000–98015 typically still carry the same patient co-pay or coinsurance as an office visit, unless a payer policy says otherwise. Make sure your billing staff knows to apply patient fees correctly based on how the payer adjudicates telehealth codes.

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.

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Why These Codes Matter

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.

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The Bottom Line

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.

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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.

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