How to Code for Telehealth: Audio-video, Audio-only, and Virtual-digital Visits 

Learn how to accurately get paid for telemedicine services with medical codes for telehealth, audio-only, and virtual-digital visits. Note: The information provided below is not intended to be advisory. The AAFP recommends that physicians verify each payer's policy and ask patients to verify their coverage ahead of appointments. 

Coding for Telehealth Visits

Coding for Audio-video Visits

How do I code a new or established patient telehealth office visit that uses audio-video communications technology?

Medicare

As of January 1, 2024, Medicare pays telehealth services provided in the patient’s home (POS 10) at the non-facility rate. Telehealth services provided at an originating site (POS 02) are paid at the facility rate. You can look up the non-facility and facility rates using the Medicare Physician Fee Schedule Lookup Tool.

*If the telehealth flexibilities are not extended beyond 2024, originating site restrictions will be reinstated for all telehealth services except for those to diagnosis, evaluation, or treatment of a mental health or substance use disorder (i.e., POS 10 will only be permitted for behavioral or mental telehealth services).

Private Payers

Commercial, self-funded, and Medicare Advantage polices regarding telehealth vary. Check with your local provider relations representative for their most recent policies.  

Medicaid

Similarly, Medicaid policies are established at the state-level. Check with your local Medicaid agency and/or Medicaid Managed Care Organizations (MCOs) for their policies.

Coding for Audio-only Visits*

How do I code an audio-only visit for a new or established patient? 

Medicare

• Beginning January 1, 2025, CPT Codes: 99441-99443 are no longer available.

• Medicare will allow use of audio-only communication technology for any telehealth service provided to a patient in their home if the physician is capable of using an audio-video telecommunications system, but the patient us unable or does not consent to use of video. A list of Medicare’s Telehealth Services is available here. Use the CPT or HCPCS code that best describes the service provided.

• Documentation must reflect that the physician has audio-video available, but the patient preferred audio-only or was unable to use audio-video.

• Append CPT modifier 93 to services provided via audio-only.    
  • Federally qualified health centers and rural health centers should use modifier FQ, 93, or both where appropriate and true, since they are identical in meaning. 

*If the telehealth flexibilities are not extended beyond 2024, audio-only telehealth will be limited to services for the diagnosis, evaluation, or treatment of a mental health or substance use disorder.

Private Payers

• Commercial, self-funded, and Medicare Advantage polices regarding telehealth vary. Check with your local provider relations representative for their most recent policies. 

Medicaid

• Similarly, Medicaid policies are established at the state-level. Check with your local Medicaid agency and/or Medicaid Managed Care Organizations (MCOs) for their policies. 

Coding for Virtual-digital Visits 

How do I code an e-visit or virtual check-in for an established patient? 

Medicare

e-Visit

Virtual check-in

Private Payers

• Commercial, self-funded, and Medicare Advantage polices regarding telehealth vary. Check with your local provider relations representative for their most recent policies. 

Medicaid

• Similarly, Medicaid policies are established at the state-level. Check with your local Medicaid agency and/or Medicaid Managed Care Organizations (MCOs) for their policies. 

Virtual/Digital Scenario Notes 

• Patient consent is required and may be obtained either before or at the time of service. 
• Virtual check-ins and e-visits must technically be initiated by a patient; however, physicians and other providers may need to educate beneficiaries on the availability of the service prior to patient initiation. 
• There are no POS or modifier requirements for virtual check-ins or e-visits. Use the POS used for typical services. 

Virtual Check-in (HCPCS Code G2012, G2252) 

• These are brief conversations with a physician or other clinician to determine if an in-person visit is necessary. 
• The communication cannot be related to a medical visit within the previous seven days and cannot lead to medical visit within the next 24 hours (or soonest appointment available). 
• Physician or other clinician may respond to patient by telephone, audio/video, secure text messaging, email, or patient portal. 
• HCPCS code G2010 can be used when a captured video or image (store and forward) is sent to the physician. The physician must follow up with the patient within 24 business hours. The consultation must not originate from an evaluation and management (E/M) service provided within the previous seven days or lead to an E/M service within the next 24 hours (or soonest available appointment). 

E-Visits (online digital evaluation and management services) 

• These are non-face-to-face, patient-initiated communications with the physician through an online patient portal. The communications can occur over a seven-day period, and the exchange must be stored permanently. 
• They are a time-based service. Physicians use the cumulative time for up to seven days to determine the level of service. 
  • Cumulative time includes review of the initial inquiry, review of patient records pertinent to the assessment of the patient’s problem, personal interaction with clinical staff focused on the patient’s problem, development of management plans (including generation of prescriptions or ordering of tests), and subsequent communication with the patient. Communication can occur through online, telephone, email, or other digitally supported communication 

Physicians and other clinicians who may independently bill Medicare for E/M services can use the following codes:

• 99421: Online digital evaluation and management service, for a patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes 
• 99422: Online digital evaluation and management service, for a patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes 
• 99423: Online digital evaluation and management service, for a patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes 

E-visits should not be billed on the same day the physician reports an office visit E/M service (CPT codes 99202-99205 and 99211-99215) for the same patient. Additionally, e-visits should not be billed when using the following codes for the same communication: 

• 99091 
• 99339-99340 
• 99374-99380 
• 99487 and 99489 
• 99495-99466