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. The right codes for Medicare, Medicaid and private payers can ensure proper payment that helps keep you connected to your patients.

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 audio-video visits

Medicare

Beneficiaries must be in an eligible originating site and located within a specific geographic area OR receiving telehealth services for the diagnosis or treatment of a mental/behavioral health condition or substance use disorder.

Medicare did not adopt the new audio-video CPT codes (98000-98007). Instead use the appropriate office visit evaluation and management CPT code as outlined below:

• As of January 1, 2024, Medicare pays for 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.
  
  
• Telehealth provided in the patient’s home is restricted to mental/behavioral health services.
  
  To be eligible to receive mental/behavioral health telehealth services in the home, the beneficiary’s home must either meet the geographic site requirement (i.e., be in a rural HPSA, outside of a MSA or in a federal health demonstration project) or meet one of the following criteria:
  
  
  • Are being treated for substance use disorder AND a co-occurring mental/behavioral health condition, or
  • had an in-person visit with the telehealth physician or clinician within six months prior to the initial telehealth visit and every 12 months thereafter. The in-person visit may be with another physician or clinician in the same subspecialty within the same group practice if the original physician or clinician is unavailable.

• Medicare does not require a modifier for audio-video telehealth services.

Private Payers

• Commercial, self-funded, and Medicare Advantage polices regarding telehealth vary, including their adoption of the new audio-video CPT codes (98000-98007). Check with your local provider relations representative for their most recent policies.  

Medicaid

• Similarly, Medicaid policies are established at the state-level, including their adoption of the new audio-video CPT codes (98000-98007). Check with your local Medicaid agency and/or Medicaid Managed Care Organizations (MCOs) for their policies.

Coding for audio-only visits

Medicare

• Effective October 1, 2025, Medicare audio-only telehealth is limited to mental/behavioral health and substance use disorder services provided to patients in their home. See above for the requirements for patients to receive telehealth services in their home.
• 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 is 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 (e.g., 99202-99215).
• Beginning January 1, 2025, CPT Codes: 99441-99443 are no longer available. Medicare did not adopt the new audio-only CPT codes (98008-98015).
• 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. 
• Documentation must reflect that the physician has audio-video available, but the patient preferred audio-only or was unable to use audio-video.

Private Payers

• Commercial, self-funded and Medicare Advantage polices regarding telehealth vary, including their coverage of audio-only and whether they adopted the new audio-only CPT codes (98008-98015). Check with your local provider relations representative for their most recent policies. 

Medicaid

• Similarly, Medicaid policies are established at the state level, including their coverage of audio-only and whether they adopted the new audio-only CPT codes (98008-98015). Check with your local Medicaid agency and/or Medicaid Managed Care Organizations (MCOs) for their policies. 

Coding for virtual-digital visits 

Medicare

eVisits and virtual check-ins are considered communication technology-based services (CTBS). They are not subject to the originating and geographic site restrictions and are not impacted by the expiration of the telehealth waivers. Practices may continue to provide CTBS to all patients regardless of where the patient is located.

e-Visit

Virtual check-in

• Medicare replaced G2012 with CPT code 98016.

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 be initiated by a patient. 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 98016, 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