all office visit cpt codes

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Office/Outpatient E/M Codes

2021 e/m office/outpatient visit cpt codes.

The tables below highlight the changes to the office/outpatient E/M code descriptors effective in 2021.

More details about these office/outpatient E/M changes can be found at CPT® Evaluation and Management (E/M) Office or Other Outpatient (99202-99215) and Prolonged Services (99354, 99355, 99356, 99XXX) Code and Guideline Changes.

All specific references to CPT codes and descriptions are © 2023 American Medical Association. All rights reserved. CPT and CodeManager are registered trademarks of the American Medical Association.

Download the Office E/M Coding Changes Guide (PDF)

CPT Office Visit Codes: A Quick Reference Guide

Table of Contents

When it comes to medical billing and coding, accurate documentation and coding of office visits is crucial for healthcare providers. This is where CPT office visit codes come into play. CPT, which stands for Current Procedural Terminology, is a system developed by the American Medical Association (AMA) to standardize the reporting of medical procedures and services. In this article, we will delve into the importance of understanding CPT office visit codes and provide you with a comprehensive quick reference guide.

Understanding CPT Office Visit Codes

CPT office visit codes are used to classify and bill for face-to-face encounters between healthcare providers and patients in an office setting. These codes help determine the appropriate level of reimbursement based on the complexity and intensity of the visit. Understanding CPT office visit codes is essential for accurate and efficient medical billing and coding.

CPT office visit codes are categorized into different levels, ranging from level 1 (lowest complexity) to level 5 (highest complexity). The codes take into account various factors such as the nature of the presenting problem, history and examination performed, and the complexity of the medical decision-making involved. It is crucial for healthcare providers to accurately document and code each office visit to ensure proper reimbursement and to provide a clear record of the patient’s medical history.

A Comprehensive Quick Reference Guide

To help healthcare providers navigate through the complexity of CPT office visit codes, we have put together a comprehensive quick reference guide. This guide outlines the key elements that should be considered when coding office visits and provides examples for each level of complexity. It also includes documentation requirements and tips to ensure accurate coding and billing.

The quick reference guide begins by explaining the different levels of CPT office visit codes and their corresponding complexity criteria. It then provides an overview of the documentation requirements for each level, including the necessary history, examination, and medical decision-making components. Additionally, the guide offers helpful coding tips and common pitfalls to avoid when coding office visits.

Accurate coding of office visits is crucial for healthcare providers to receive appropriate reimbursement and ensure compliance with billing regulations. The use of CPT office visit codes streamlines the billing process and provides a standardized framework for reporting medical services. By understanding the nuances and requirements of CPT office visit codes, healthcare providers can ensure proper documentation and coding, resulting in accurate reimbursement and a clear record of the patient’s medical history. Utilizing a comprehensive quick reference guide can greatly assist in this process, helping healthcare providers navigate the complexities of CPT office visit codes effectively.

What are CPT Office Visit Codes, and why are they important in medical coding ?

CPT Office Visit Codes are a set of Current Procedural Terminology codes specifically designed to represent various types of patient encounters in an office setting. These codes play a crucial role in medical coding as they help define and categorize the complexity and nature of office visits, aiding in accurate billing and reimbursement.

How are CPT Office Visit Codes structured, and what do the different levels (e.g., 99201-99215) signify?

CPT Office Visit Codes are structured into different levels, typically ranging from 99201 to 99215. These levels signify the complexity of the office visit, taking into account factors such as the extent of the history, examination, and medical decision-making. Higher-level codes represent more complex and comprehensive visits.

What criteria should healthcare providers consider when selecting the appropriate CPT Office Visit Code for a patient encounter?

Healthcare providers should consider factors such as the patient’s history, the extent of the physical examination, and the complexity of medical decision-making. The documentation should support the level of service provided during the office visit to ensure accurate code selection.

How do CPT Office Visit Codes impact reimbursement, and why is it important for healthcare providers to accurately assign these codes?

CPT Office Visit Codes directly influence reimbursement, as they are used by payers to determine the appropriate payment for services. Accurate code assignment is crucial for healthcare providers to receive fair compensation for the level of care provided during office visits and to avoid potential billing errors.

Are there specific documentation requirements that healthcare providers should follow when using CPT Office Visit Codes?

Yes, there are specific documentation requirements for each level of CPT Office Visit Code. Providers should ensure thorough documentation of the patient’s history, examination findings, and medical decision-making. Clear and detailed documentation supports the assigned code and helps in justifying the level of service provided.

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Evaluation and management (E/M) services are an essential part of medical practices, especially in family medicine. These services are categorized using Current Procedural Terminology (CPT) codes for billing purposes. Properly documenting and coding for E/M services is crucial to maximize payment and minimize audit-related stress.

There are different levels of E/M codes, determined by the medical decision-making or time involved. It’s worth noting that the guidelines for E/M coding have undergone changes, including the elimination of history and physical exam elements, revisions to the MDM table, and an expanded definition of time for E/M services.

Key Takeaways:

• Understanding E/M codes and guidelines is crucial for accurate billing.
• There are different levels of E/M codes based on medical decision-making or time involved.
• Recent changes to E/M coding include the elimination of history and physical exam elements.
• The definition of time for E/M services has been expanded.
• Proper documentation and coding help maximize payment and reduce audit-related stress.

Overview of Office Visit CPT Code Changes

The CPT Editorial Panel made significant revisions to the documentation and coding guidelines for office visit E/M services in 2021, with further changes introduced in 2023. These updates aim to simplify documentation requirements, reduce administrative burden, and ensure accurate coding for evaluation and management services.

One of the key changes introduced is the addition of add-on code G2211. This code accounts for the resource costs associated with visit complexity inherent to primary care and other longitudinal care settings. The inclusion of this add-on code reflects a more comprehensive understanding of the unique challenges and workload associated with these types of visits.

Additionally, the revisions eliminate the requirement for history and physical exam elements to be considered in E/M code level selection. This change allows healthcare providers to focus more on medical decision-making (MDM) and limits the need for extensive documentation of these elements in the medical record.

The MDM table has also been revised to better reflect the cognitive work required for evaluation and management services. This ensures that the complexity of the MDM is accurately captured in the coding process and supports appropriate reimbursement for the level of care provided.

Furthermore, the definition of time for many E/M services has been expanded. The expanded definition of time includes both face-to-face and non-face-to-face components of care on the day of the encounter. This change recognizes the comprehensive nature of care provided and allows for a more accurate reflection of the time spent in the management of the patient.

Using Total Time for Office Visit CPT Code Selection

When it comes to selecting the appropriate office visit CPT code, total time can be a valuable factor to consider. Total time refers to the sum of all the physician’s or qualified health professional’s (QHP) time spent in caring for the patient, both face-to-face and non-face-to-face, on the day of the encounter. This expanded definition of time allows for a more comprehensive evaluation and management of the patient’s needs.

Total time can be utilized in selecting the level of service for various evaluation and management services, including office visits, inpatient and observation care, consultations, nursing facility services, home and residence services, and prolonged services. It provides a broader perspective on the physician’s involvement in the patient’s care, taking into account all aspects of their interaction.

However, it’s important to note that for emergency department visits, the level of service is still determined primarily by medical decision-making (MDM), rather than total time. This distinction recognizes the critical nature of emergency care and the need for prompt assessment and action.

Accurate documentation of the total time spent is key to ensuring proper code selection and appropriate reimbursement. The total time should be well-documented in the patient’s medical record, including both the face-to-face and non-face-to-face components of the encounter. This documentation serves as a crucial reference point for billing and auditing purposes.

To summarize, total time offers a comprehensive perspective on the physician’s engagement with the patient, encompassing both face-to-face and non-face-to-face interactions. It allows for a more accurate selection of office visit CPT codes and ensures the appropriate level of reimbursement for the provided services. Proper documentation of total time is essential to support the medical necessity of the encounter and maintain compliance with coding and billing guidelines.

Documentation Requirements for Total Time Calculation

When determining the total time for selecting office visit CPT codes, it is essential to adhere to specific documentation requirements. By accurately documenting the time spent on various activities during the encounter, healthcare providers can ensure proper code selection and optimize reimbursement.

To calculate the total time for office visit code selection, the following activities should be included:

• Reviewing external notes/tests
• Performing an examination
• Counseling and educating the patient
• Documenting in the medical record

These activities reflect the time personally spent by the physician or qualified health professional (QHP) on the date of the encounter. However, there are also activities that should be excluded when calculating total time:

• Time spent on activities typically performed by ancillary staff
• Time related to separately reportable activities

It is crucial to specifically document the total time spent on each activity during the date of the encounter, rather than providing generic time ranges. This detailed documentation ensures transparency and accuracy in code selection and reimbursement.

In addition to capturing face-to-face time, it is important to record non-face-to-face time as well. Non-face-to-face time includes tasks performed outside of direct interaction with the patient, such as reviewing test results or consulting with other healthcare professionals.

Example of Total Time Calculation:

Let’s consider an example where a family physician spends the following time on a patient encounter:

• 45 minutes performing an examination and counseling
• 15 minutes reviewing external notes/tests
• 10 minutes documenting in the medical record
• 5 minutes discussing with an ancillary staff

In this case, the total time would be calculated as follows:

By accurately documenting the specific total time spent on each activity and excluding ancillary staff time, healthcare providers can ensure proper code selection and reimbursement. This meticulous documentation of total time in the medical record provides a comprehensive overview of the services rendered and supports accurate billing.

Split or Shared Visit Documentation Guidelines

A split or shared visit occurs when a physician and other qualified health professional (QHP) provide care to a patient together during a single Evaluation and Management (E/M) service. In such cases, the time personally spent by the physician and QHP on the date of the encounter should be summed to define the total time.

However, only distinct time should be counted. This means that overlapping time during jointly meeting with or discussing the patient should not be double-counted. The distinct time should represent the unique contribution of each provider involved in the split or shared visit.

It is important to note that time spent on activities performed by ancillary staff should not be included in the total time calculations. The total time should only reflect the face-to-face time and distinct time spent by the physician and other QHP directly involved in providing the medically necessary services.

Documentation should support the medical necessity of both services reported in a split or shared visit scenario. This includes clearly documenting the need for both physicians or QHPs to be involved and the services each provider contributed to the patient’s care.

Applying Total Time to Specific E/M Services

Total time is a valuable tool for selecting the appropriate level of service for a variety of Evaluation and Management (E/M) services. This method can be applied to different specific E/M services, ensuring that the level of care is clinically appropriate and adequately reimbursed. By considering the total time spent during the encounter, healthcare providers can accurately assign the appropriate office visit CPT code.

The application of total time is not limited to office visit services. It can also be used for inpatient and observation care services, hospital inpatient or discharge services, consultation services, nursing facility services, and home or residence services. This flexibility allows for a comprehensive approach to E/M coding, regardless of the specific type of service provided.

When selecting the visit level based on total time, it is important to ensure that the encounter is counseling-dominated. While total time can be used as the sole determinant for selecting the visit level, counseling should still play a significant role in the encounter. This ensures that the level of service reflects the complexity and intensity of the counseling provided during the visit.

It is crucial to emphasize that total time should be clinically appropriate and supported by documentation in the medical record. This documentation should clearly demonstrate the medical necessity of the services provided and the time spent on the date of the encounter.

Applying Total Time to E/M Services: An Example

To illustrate the application of total time to specific E/M services, let’s consider an example of an office visit for a counseling-dominated encounter:

In this example, the total time spent during the encounter determines the appropriate level of visit code. For a total time of 25 minutes, a level 3 visit (CPT code 99213) is selected. If the total time is 40 minutes, a level 4 visit (CPT code 99214) would be appropriate. Finally, a total time of 60 minutes would result in a level 5 visit (CPT code 99215).

By applying total time to specific E/M services, healthcare providers can ensure accurate coding and appropriate reimbursement for the care provided. This method promotes comprehensive and patient-centered care while maintaining compliance with coding guidelines. Understanding the nuances of applying total time is essential for optimizing billing practices and promoting quality healthcare delivery.

Caveats and Considerations for Time-based E/M Coding

When utilizing time as the basis for selecting E/M codes, there are important caveats and considerations to keep in mind. Time-based coding should only be used in situations where counseling dominates the encounter, and it should not include time spent on separately reportable services. Documentation should clearly indicate that the services provided were not duplicative and were necessary for the management of the patient. Additionally, it is crucial to note that the professional component of diagnostic tests/studies and activities performed on a separate date should not be included in the total time calculation.

Considerations for Time-based E/M Coding

• Use time-based coding only when counseling dominates the encounter.
• Exclude time spent on separately reportable services.
• Ensure documentation supports the necessity of the provided services.
• Do not include the professional component of diagnostic tests/studies.

Implications of Time-based E/M Coding

When selecting E/M codes based on time, it is important to adhere to the specified guidelines and considerations. Failing to do so can lead to inaccurate coding, reimbursement issues, and potential compliance concerns. By understanding the requirements and accurately documenting the relevant information, healthcare providers can ensure proper medical billing and maintain compliance with coding and documentation guidelines.

Documentation Requirements for Time-based E/M Coding

Updates and Changes to CPT E/M Guidelines

The CPT Editorial Panel has recently implemented updates and changes to the Evaluation and Management (E/M) guidelines, specifically focusing on medical decision making (MDM), history, and exam. These updates aim to enhance the accuracy and specificity of E/M coding and documentation.

One significant change in the new guidelines is the emphasis on a medically appropriate history or exam, rather than relying solely on the number or complexity of problems addressed. This shift highlights the importance of gathering comprehensive patient information to guide medical decision making.

The MDM levels have also been revised to align with those used for office visits. This alignment ensures consistency across different types of E/M services and facilitates accurate code selection for medical billing and reimbursement.

By updating and refining the guidelines, the CPT Editorial Panel aims to streamline the coding and documentation process, making it easier for healthcare providers to accurately capture the complexity of patient encounters and facilitate proper reimbursement.

Changes in CPT E/M Guidelines

| Old Guidelines | Updated Guidelines | |—————————-|———————————| | Emphasized number of | Emphasize medically appropriate | | problems addressed | history or exam | | MDM levels differed across | MDM levels align with office | | different E/M services | visit levels | | | |

The updates in the CPT E/M guidelines bring about significant changes in capturing the complexity of patient encounters. Healthcare providers should familiarize themselves with these updates to ensure compliance with the revised guidelines, thereby facilitating accurate coding, billing, and reimbursement.

Guidelines for MDM Selection in E/M Services

In the process of selecting the appropriate E/M codes for evaluation and management (E/M) services, medical decision making (MDM) plays a crucial role. MDM encompasses several factors that need to be considered, including the number and complexity of problems addressed, comorbidities, the amount and complexity of data reviewed and analyzed, and the risk of complications, morbidity, or mortality.

It is important to note that the final diagnosis alone does not determine the complexity of MDM. Rather, the complexity is determined by the impact of the condition on the management of the patient. The more complex the problems, comorbidities, and data analysis, as well as the higher the risk of complications, morbidity, or mortality, the more intricate the MDM.

In accurately reflecting the level of complexity in the documentation and coding of E/M services, healthcare providers ensure proper reimbursement and compliance with coding guidelines. By carefully evaluating the factors that contribute to MDM, providers can effectively demonstrate the complexity of the problems addressed and the resources required to manage them.

Here is a breakdown of the key considerations for MDM selection in E/M services:

• Number and complexity of problems addressed
• Comorbidities
• Amount and complexity of data reviewed and analyzed
• Risk of complications, morbidity, or mortality
• Final diagnosis and its impact on management
• Complexity of problems and their management

Accurately documenting and coding the appropriate level of MDM is essential for ensuring proper reimbursement and comprehensive representation of the complexity of the patient’s condition. It is crucial to pay attention to the specifics of each patient’s case and make informed decisions based on thorough evaluation and analysis.

Impact of Office Visit CPT Code Changes on Medical Billing

The changes in office visit CPT code guidelines have had a significant impact on medical billing and reimbursement. Healthcare providers must adapt to these changes and understand the documentation requirements and accurate coding necessary to ensure proper reimbursement and reduce the risk of audits.

Accurate coding is crucial in accurately reflecting the level of service provided during the office visit. It ensures that healthcare providers receive accurate reimbursement for their services and helps to reduce the burden of potential audits. Proper documentation and coding also contribute to compliance with coding and documentation requirements, mitigating the risk of financial loss and noncompliance.

It is essential for healthcare providers to familiarize themselves with the new guidelines and understand how to properly document the relevant information. This includes accurately capturing the level of service provided, the complexity of problems addressed, and the time spent on the date of the encounter. By adhering to these documentation requirements, healthcare providers can ensure accurate coding and reimbursement, reducing the risk of claims denials or audits.

Proper documentation not only helps in accurate coding and reimbursement but also simplifies auditing processes, ensuring compliance with coding and documentation requirements. Auditing plays a vital role in the healthcare system, and having the appropriate documentation in place can streamline the auditing process and provide evidence of accurate and compliant billing practices.

Compliance with coding and documentation requirements is essential to avoid potential financial loss and maintain a good standing within the healthcare industry. By accurately documenting and coding office visit services, healthcare providers can demonstrate their commitment to compliance and ensure that they are providing high-quality care to their patients.

In conclusion, the changes in office visit CPT code guidelines have had a significant impact on medical billing and reimbursement. It is crucial for healthcare providers to understand the documentation requirements, accurately code the services provided, and ensure compliance with coding and documentation guidelines. By doing so, healthcare providers can streamline the billing process, reduce the risk of audits, and ensure accurate reimbursement for their services.

Resources for Understanding Office Visit CPT Code Guidelines

When it comes to understanding the guidelines for office visit CPT codes and navigating the changes in E/M coding, healthcare providers can rely on valuable resources provided by reputable organizations such as the American Medical Association (AMA) and the Medicare Learning Network (MLN). These resources offer comprehensive guidance and tools that can help healthcare providers stay up to date and ensure accurate reimbursement.

The CPT Evaluation and Management Services Guidelines, developed by the AMA, provide detailed information on office visit CPT codes, E/M coding principles, and documentation requirements. This resource serves as a comprehensive guide to help healthcare providers understand the intricacies of office visit coding and ensure compliance with the latest guidelines.

The Medicare Learning Network, an educational resource developed by the Centers for Medicare & Medicaid Services (CMS), offers webinars, articles, and other educational materials specifically designed to assist healthcare providers in understanding and implementing the changes in E/M coding. These resources provide practical insights and clarification on the documentation requirements and coding changes specific to office visit CPT codes.

Furthermore, the Medicare Physician Fee Schedule Lookup Tool, available on the CMS website, enables healthcare providers to access reimbursement information for specific office visit CPT codes. This tool allows providers to accurately determine the appropriate reimbursement for their services and ensure proper billing practices.

By leveraging these resources, healthcare providers can enhance their understanding of office visit CPT code guidelines, navigate the complexities of E/M coding, and ensure accurate reimbursement for their services. Staying informed and utilizing these valuable resources is imperative for maintaining compliance and optimizing coding practices.

Understanding the guidelines for office visit CPT codes is essential for accurate medical billing and insurance reimbursement. The recent changes in E/M coding guidelines, particularly regarding time-based code selection and medical decision making, necessitate proper documentation and accurate coding. By comprehensively understanding these guidelines, healthcare providers can maximize their payment, reduce the stress associated with audits, and ensure compliance with coding and documentation requirements.

Accurate medical billing is crucial for healthcare practices to receive fair reimbursement from insurance companies. By following the comprehensive guide provided by the American Medical Association (AMA) and the Medicare Learning Network (MLN), healthcare providers can confidently navigate the complexities of office visit CPT codes. This comprehensive guide provides detailed information on selecting the appropriate codes based on medical decision making, time-based code selection, and documentation requirements.

Properly documenting the relevant information and coding accurately not only ensures accurate reimbursement but also reduces the risk of audits and increases compliance. By adhering to the guidelines and best practices outlined in the comprehensive guide, healthcare providers can maintain accurate and compliant medical billing practices, ultimately benefiting both their practice and their patients.

In conclusion, understanding the guidelines for office visit CPT codes is crucial for accurate medical billing and insurance reimbursement. By following the comprehensive guide provided by industry resources such as the AMA and MLN, healthcare providers can navigate the changes in E/M coding and ensure compliance with coding and documentation requirements. This comprehensive understanding of the guidelines allows healthcare providers to optimize payment, minimize audit-related stress, and maintain accurate and compliant medical billing practices.

What are office visit CPT codes?

Office visit CPT codes are evaluation and management (E/M) codes used for billing purposes in family medicine practices and other healthcare settings.

What are the changes to the office visit CPT code guidelines?

The office visit CPT code guidelines have been revised to eliminate the history and physical exam elements, introduce an add-on code for visit complexity, revise the medical decision-making table, and expand the definition of time for E/M services.

How can total time be used for office visit CPT code selection?

Total time, which includes both face-to-face and non-face-to-face interactions, can be used to select the level of service for office visit codes and other E/M services.

What should be included in the calculation of total time for office visit code selection?

Activities such as examining the patient, counseling and educating the patient, reviewing external notes/tests, and documenting in the medical record should be included in the calculation of total time. Ancillary staff time and time related to separately reportable activities should be excluded.

How should total time be documented for office visit code selection?

It is important to document the specific total time spent on activities on the date of the encounter in the patient’s medical record, rather than providing generic time ranges.

What are the documentation guidelines for split or shared visits?

In a split or shared visit scenario, the time personally spent by the physician and other qualified health professional (QHP) should be summed to define total time. Distinct time should be counted, and time spent on activities performed by ancillary staff should not be included.

Can total time be used for other E/M services besides office visits?

Yes, total time can be used to select the level of service for inpatient and observation care services, hospital inpatient or discharge services, consultation services, nursing facility services, and home or residence services.

What are the caveats and considerations for time-based E/M coding?

Time-based coding should only be used when counseling dominates the encounter, and it should not include time spent on separately reportable services. It is important to ensure that the services provided were necessary for the management of the patient.

What updates have been made to the CPT E/M guidelines?

The CPT E/M guidelines have been updated to emphasize the need for a medically appropriate history or exam and to revise the levels of medical decision making to align with office visit levels.

How is medical decision making (MDM) determined in E/M services?

MDM is determined by considering the number and complexity of problems addressed, comorbidities, the amount and complexity of data reviewed and analyzed, and the risk of complications, morbidity, or mortality.

What is the impact of the office visit CPT code changes on medical billing?

The changes in office visit CPT code guidelines have a significant impact on medical billing, requiring proper documentation and accurate coding to ensure accurate reimbursement and reduce the risk of audits.

Where can healthcare providers find resources to understand the office visit CPT code guidelines?

Healthcare providers can refer to resources such as the CPT Evaluation and Management Services Guidelines from the American Medical Association and the Medicare Learning Network for guidance on understanding and implementing the office visit CPT code guidelines.

What is the importance of understanding office visit CPT code guidelines?

Understanding office visit CPT code guidelines is crucial for accurate medical billing, insurance reimbursement, and compliance with coding and documentation requirements.

What is the overall purpose of the comprehensive guide on office visit CPT code guidelines?

The comprehensive guide on office visit CPT code guidelines provides healthcare providers with a thorough understanding of the guidelines, enabling them to maximize payment, reduce the stress associated with audits, and ensure compliance with coding and documentation requirements.

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What Are CPT Codes?

• Where Codes Are Used
• Codes and Services
• Coding Errors

HCPCS Codes

Frequently asked questions.

Current Procedural Terminology (CPT) codes are numbers assigned to each task and service that you can get from a healthcare provider. For example, a routine check-up or a lab test has a code attached to it.

CPT codes are used to track and bill medical, surgical, and diagnostic services. Insurers use CPT codes to determine how much money to pay providers.

The same CPT codes are used by all providers and payers to make the billing process consistent and to help reduce errors.

This article will go over what CPT codes are used for and what problems you might encounter related to CPT codes on your medical or insurance records.

Courtney Hale / Getty Images

A CPT code is usually a five-digit numeric code. However, some CPT codes are four numbers and one letter. A CPT code has no decimal points.

Some CPT codes are only used occasionally and some are not really used at all. Other CPT codes are used frequently. For example, 99213 and 99214 are codes for general office visits, usually to address one or more new concerns or complaints, or to follow up on one or more problems from a previous visit.

The American Medical Association (AMA) develops, maintains, and has copyrighted the CPT codes that are used today all over the world. These codes can change as healthcare changes, and new codes can be made and assigned to new services.

Current CPT codes can also be revised and unused codes thrown out. Thousands of CPT codes are used and updated every year.

Limitations of CPT Codes

While they are meant to help make the billing process in healthcare more uniform, the existence of CPT codes does not mean that everyone defines a healthcare service the same way.

CPT codes also do not ensure that different healthcare providers will get paid the same amount for the same service because payment is outlined in the contracts between providers and insurers.

For example, Healthcare Provider A may perform a physical check-up (99396) and be paid $100 by your insurance company. However, if you went to Healthcare Provider B, the payment for that same CPT code might only be $90.

Verywell / Laura Porter

Types of CPT Codes

There are several categories of CPT codes:

• Category I: Procedures, services, devices, and drugs (including vaccines )
• Category II: Performance measures and quality of care (for example, patient follow-up)
• Category III: Services and procedures using emerging technology (these codes are usually temporary while the service or procedure is still fairly new)
• PLA codes: Used for lab testing

List of CPT codes

Here are some examples of CPT codes:

• 99214 can be used for an office visit
• 99397 can be used for a preventive exam if you are over age 65
• 90658 can be used for the administration of a flu shot
• 90716 can be used for the administration of the chickenpox vaccine (varicella)
• 12002 can be used when a healthcare provider stitches up a 1-inch cut on your arm
• 87635 can be used when you're given a COVID-19 test

Bundled Services

Bundled services are a single CPT code that describes several services that are performed together.

For example, if you break your arm and get an X-ray and a cast, these services might be bundled under one code for billing.

How CPT Codes Are Used

CPT codes directly affect how much a patient will pay for the medical care they receive.

Provider offices, hospitals, and other medical facilities are strict about how CPT coding is done. They hire professional medical coders or coding services to make sure that services are coded correctly.

Initial Coding

Your healthcare provider or their office staff will usually start the coding process.

If they use paper forms, they will list which CPT codes apply to your visit. If they use an electronic health record (EHR) during your visit, it will be noted in that system. These systems usually let staff call up codes based on the service name.

What’s the Difference Between a CPT Code and a ICD Code?

CPT codes have different uses than ICD codes . CPT codes identify the services provided to a patient, and ICD codes identify diagnoses. The CPT code system is managed by the American Medical Association, while the ICD code system is managed by the World Health Organization. 

Verification and Submission

After you leave the office, medical coders and billers examine your records. They make sure the correct CPT codes are assigned.

Next, the billing department submits a list of your services to your insurer or payer. Most healthcare providers store and transfer this information digitally, but some are still done by mail or fax.

Claim Processing

Your health plan or payer uses CPT codes to process the claim. They will decide how much to pay your provider and how much you will owe for the services that you got.

Health insurance companies and government officials use coding data to predict future health care costs for the patients in their systems.

State and federal government analysts use coding data to track trends in medical care. This information helps to plan and budget for Medicare and Medicaid.

Where You Will See CPT Codes

You'll see CPT codes in many different documents that you'll get as you move through the healthcare system.

Discharge Paperwork

When you are done with an appointment or are discharged from a healthcare facility, you will get some paperwork to take home with you. It usually includes a summary of the services you had, including the codes for those services.

The five-character codes are usually CPT codes. There are also other codes on that paperwork, like ICD codes that indicate a diagnosis (which may have numbers or letters, and usually decimal points).

When you get a medical bill, it will have a list of the services you received. Next to each service will be a five-digit code—usually, it's the CPT code.​

Explanation of Benefits

When you receive an explanation of benefits (EOB) from your payer, it will show how much of the cost of each service was paid on your behalf. Each service will be matched with a CPT code.

Matching CPT Codes to Services

If you're looking at your healthcare providers' and insurance billing process, you might want to know what all the codes mean.

However, CPT codes are copyrighted by the AMA and they charge a fee to use them. That means that you will not find a full list of CPT codes with explanations online for free.

That said, the AMA does provide consumers with a way to look up the CPT codes. Here's how to find out what a CPT code means:

• Do a CPT code search on the AMA website . You will have to register (for free). You are limited to five searches per day. You can search by a CPT code or use a keyword to see what the code for a service might be.
• Contact your healthcare provider's office and ask them to help you match the CPT codes and services.
• Contact your payer's billing department and ask them to help you with the CPT codes.

You can use the same steps to look up bundled codes.

Preventing Incorrect Coding

Understanding CPT codes can help you make sure that your hospital bill is correct and catch any billing errors—which do happen often. Some patient advocacy groups say that nearly 80% of bills for medical care contain minor errors.

These simple mistakes can have a big impact on your wallet. In fact, the wrong CPT code can mean that your insurance will not cover any of the costs.

Always review your bill carefully and compare it with your EOB to check for mistakes. It's not uncommon for healthcare providers or facilities to code for the wrong type of visit or service (typographical errors).

There are also fraudulent practices like "upcoding," which is when you are charged for a more expensive service than the one you got. On the other hand, "unbundling" is when bundled services or procedures are billed as separate charges.

If you come across something in your medical bill that doesn't add up, call your provider's office. It could be a simple mistake that the billing department can fix.

CPT codes are similar to codes from the Healthcare Common Procedure Coding System (HCPCS). If you use Medicare, you'll see HCPCS codes in your paperwork instead of CPT codes.

HCPCS codes are used and maintained by the Centers for Medicare & Medicaid Services (CMS). They are used to bill Medicare, Medicaid, and many other third-party payers.

HCPCS Code Levels

• Level I codes are based on CPT codes and are used for services and procedures that are offered by healthcare providers.
• Level II codes cover healthcare services and procedures that are not performed by healthcare providers.

HCPCS level II codes start with a letter and have four numbers. They may also have extra modifiers—either two letters or a letter and a number. Examples of items billed with level II codes are medical equipment, supplies, and ambulance services .

HCPCS level II code lists can be found on the CMS website . Level I codes, however, are copyrighted by the AMA just like CPT codes.

CPT codes are combinations of letters and numbers that match up with healthcare services and supplies. The AMA developed CPT codes to make sure that all healthcare providers have a uniform system for reporting the services they give to patients.

When you visit a healthcare facility, your provider uses CPT codes to let your insurer or payer know which services you got from them. The insurer or payer then reimburses the provider based on the CPT codes. You can see the codes on your discharge paperwork, bills, and benefit statements.

It's a good idea to check the codes when you receive a bill or statement. Your provider or the coder can sometimes make errors and if they're not fixed, you could pay more than you should have to.

Healthcare Common Procedure Coding System (HCPCS) codes are used by the Centers for Medicare and Medicaid Services (CMS) to bill Medicare, Medicaid, and other third-party payers.

HCPCS codes are separated into two levels of codes:

• Level I: Based on CPT codes, these are used for services or procedures often provided by healthcare providers.
• Level II: These codes cover health care services or procedures that healthcare providers do not offer. Examples include medical equipment, supplies, and ambulance services.

An encounter form keeps track of the diagnosis and procedure codes that are recorded when a patient visits a provider's office. The purpose of the form is to make sure the billing is correct and a receipt can be offered to the patient after the visit.

The six sections of CPT codes are Evaluation and Management, Anesthesia, Surgery, Radiology, Pathology and Laboratory, and Medicine. Each of the six sections also has sections within it that offer more detail about services.

Some of the most frequently used CPT codes are:

99201-05 (New Patient Office Visit)

99211-15 (Established Patient Office Visit)

99221-23 (Initial Hospital Care for New or Established Patient)

99231-23 (Subsequent Hospital Care)

99281-85: (Emergency Department Visits)

9241-45 (Office Consultations)

The CPT codes are currently used in over 60 countries.

American Medical Association. CPT® purpose & mission .

American Medical Association. CPT® overview and code approval .

American Medical Association. New CPT code for COVID-19 testing: What you should know .

Centers for Disease Control and Prevention. International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Clinical Modification (ICD-10-CM) .

Kaiser Family Foundation.  Studies find high rates of errors on medical billing .

Centers for Medicare & Medicaid Services. HCPCS coding questions .

American Association of Professional Coders. What is CPT ® ?

Meditec. Commonly used CPT codes in medical coding .

American Medical Association. CPT international .

By Trisha Torrey  Trisha Torrey is a patient empowerment and advocacy consultant. She has written several books about patient advocacy and how to best navigate the healthcare system. 

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List of CPT/HCPCS Codes

We maintain and annually update a List of Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) Codes (the Code List), which identifies all the items and services included within certain designated health services (DHS) categories or that may qualify for certain exceptions. We update the Code List to conform to the most recent publications of CPT and HCPCS codes and to account for changes in Medicare coverage and payment policies. Code List updates for years 2022 and earlier were published in the Federal Register as an addendum to the annual Physician Fee Schedule final rule. 

Beginning with the Code List effective January 1, 2023, updates are published solely on this webpage.  On or before December 2 nd of each year, we will publish the annual update to the Code List and provide a 30-day public comment period using www.regulations.gov . To be considered, comments must be received within the stated 30-day timeframe. We anticipate that most comments will be addressed by April 1 st ; however, a longer timeframe may be necessary to address complex comments or those that require coordination with external parties. If no comments are received, in lieu of a comment response, we will publish a note below the applicable Code List year stating so. 

2024 Annual Update to the Code List

Below you will find the Calendar Year (CY) 2024 Code List published November 29, 2023 and a description of the revisions for CY 2024, our response to comments on that Code List, and the updated CY 2024 Code List, which is effective January 1, 2024 unless otherwise indicated on the Code List.

• UPDATED list of codes effective January 1, 2024, published March 1, 2024 (all codes effective January 1, 2024 unless otherwise indicated on the Code List) (ZIP)
• List of codes effective January 1, 2024, published November 29, 2023 (ZIP)
• Annual Update to the List of CPT/HCPCS Codes Effective January 1, 2024 (PDF)

We received one comment related to the additions, deletions, and corrections to the codes on the Code List effective January 1, 2024. Our response to this comment is below. We also received one comment related to Medicare coverage for platelet-rich plasma treatments. We consider this comment to be outside the scope of the annual update. CMS does not respond to out of scope comments on the annual updates to the Code List. 

Comment : One commenter noted that, although most Hepatitis B vaccine codes are identified on the Code List as CPT/HCPCS codes to which the exception for preventive screening tests and vaccines at § 411.355(h) applies, the Hepatitis B vaccine associated with CPT code 90739 was not listed. The commenter requested that CPT code 90739 be added to the list of vaccine codes to which the exception for preventive screening tests and vaccines at §411.355(h) applies, effective retroactively to January 1, 2024.

Response : We agree with the commenter that the exception for preventive screening tests and vaccines at § 411.355(h) should apply to CPT code 90739 and are revising the Code List accordingly. The applicability of the exception for preventive screening tests and vaccines to CPT code 90739 is prospective only and effective on the date indicated on the UPDATED list of codes. 

In considering this comment, we also identified two CPT codes (90653 and 90658, both flu vaccines) that were inadvertently left off of the list of codes to which the exception for preventive screening tests and vaccines at § 411.355(h) should apply. Accordingly, we are adding these CPT codes to the list of codes to which the exception at § 411.355(h) applies, effective on the date indicated on the UPDATED list of codes.

2023 Annual Update to the Code List

Below you will find the Code List that is effective January 1, 2023 and a description of the revisions effective for Calendar Year 2023. 

• List of codes effective January 1, 2023, published December 1, 2022
• Annual Update to the List of CPT/HCPCS Codes Effective January 1, 2023, published December 1, 2022 (PDF)

The comment period ended December 30, 2022. We did not receive any comments related to the additions, deletions, and corrections to the codes on the Code List effective January 1, 2023. We received one (1) comment related to the supervision level required for specific services. We consider this comment to be outside the scope of the annual update. CMS does not respond to out of scope comments on the annual updates to the Code List. 

DHS Categories

The DHS categories defined by the Code List are:

• clinical laboratory services;
• physical therapy services, occupational therapy services, outpatient speech-language pathology services;
• radiology and certain other imaging services; and
• radiation therapy services and supplies.

The Code List also identifies those items and services that may qualify for either of the following two exceptions to the physician self-referral prohibitions: 

• EPO and other dialysis-related drugs (42 CFR § 411.355(g)).
• Preventive screening tests and vaccines (42 CFR § 411.355(h)).

NOTE: The following DHS categories are defined at 42 CFR §411.351 without reference to the Code List:

• durable medical equipment and supplies;
• parenteral and enteral nutrients, equipment and supplies;
• prosthetics, orthotics, and prosthetic devices and supplies;
• home health services;
• outpatient prescription drugs; and
• inpatient and outpatient hospital services.

Related Links

• List of codes effective January 1, 2022, published November 19, 2021
• List of codes effective January 1, 2021, issued December 1, 2020
• List of codes effective January 1, 2020, published December 2, 2019
• List of codes effective January 1, 2019, published November 23, 2018
• List of codes effective January 1, 2018, published November 3, 2017 [ZIP, 59KB]
• List of codes effective January 1, 2017, published November 16, 2016 [ZIP, 54KB]
• List of codes effective January 1, 2016, published October 30, 2015 [ZIP, 58KB]
• List of codes effective January 1, 2015, published November 13, 2014 (79 FR 67972) [ZIP, 54KB]
• List of codes effective January 1, 2014, published December 10, 2013 (78 FR 74791) [ZIP, 54KB]
• List of codes effective January 1, 2013, published November 16, 2012 (77 FR 69334) [ZIP, 54KB]

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How Prosecutors Made the Case Against Trump

Over six weeks and the testimony of 20 witnesses, prosecutors wove a sprawling story of election interference and falsified business records.

• Share full article

By Kate Christobek

• May 30, 2024

For years, prosecutors debated, fought and even, in at least two cases, resigned over the fate of the Manhattan district attorney’s investigation into Donald J. Trump. Some legal experts predicted it would be the downfall of the district attorney, Alvin L. Bragg.

But on Thursday, a jury swiftly and decisively vindicated the risky strategy that Mr. Bragg employed to bring 34 felony counts against the former president.

Prosecutors were helped by state election law, two judges who allowed their novel legal theory to proceed and their ability to make the most of a high-risk witness, Mr. Trump’s former fixer, Michael D. Cohen.

The jury’s verdict — guilty on all 34 felony counts — represented a landmark victory for Mr. Bragg, who claimed a place in history as the first prosecutor to indict, prosecute and convict a former U.S. president.

“I did my job,” he said at a news conference after the verdict. “Our job is to follow the facts without fear or favor and that’s what we did here.”

The Trump Manhattan Criminal Verdict, Count By Count

Former President Donald J. Trump faced 34 felony charges of falsifying business records, related to the reimbursement of hush money paid to the porn star Stormy Daniels in order to cover up a sex scandal around the 2016 presidential election.

Prosecutors had to persuade jurors that Mr. Trump had falsified records to cover up a sex scandal that threatened to derail his 2016 presidential campaign. They faced an uphill battle, taking jurors on a complex and winding decade-long journey from a Lake Tahoe, Nev., celebrity golf tournament all the way to the Oval Office.

They were buoyed by the fine print of New York State law. Prosecutors needed to show only that Mr. Trump “caused” the business records to be false, rather than orchestrating the scheme or personally falsifying them.

But to make the case that Mr. Trump’s actions rose to the level of a felony, they also had to show that Mr. Trump falsified the records to conceal a second crime. This element of the case discouraged Mr. Bragg’s predecessor, Cyrus R. Vance Jr., from moving forward. But Mr. Bragg, a career prosecutor and something of a legal wonk, pushed his prosecutors to scour the penal code for a workable theory.

After months of internal deliberations, Mr. Bragg settled on an argument that Mr. Trump had violated an obscure state election law. This novel and untested theory — applying a state election law to a federal campaign — became fodder for Mr. Trump’s lawyers, who argued that the prosecutors’ case was flimsy at best. Two judges ruled that the prosecutors had legal grounds to pursue the case, but it will also have to withstand an appeal, which Mr. Trump has already indicated he will file.

Over the course of six weeks and the testimony of 20 witnesses, prosecutors wove a sprawling yet granular story of election interference and falsified business records, convincing 12 New Yorkers beyond a reasonable doubt that Mr. Trump was guilty of felony crimes. They called many of Mr. Trump’s former employees and allies who, as the prosecutor Joshua Steinglass said in his closing argument, had no motive to fabricate their testimony. If anything, he added, they had an incentive to skew it to help the former president.

Their testimony, coupled with thousands of pages of documentary evidence and Mr. Trump’s own words, allowed prosecutors to bolster their case before the jurors heard from two key witnesses whose credibility would be aggressively attacked: Mr. Cohen and the porn actress Stormy Daniels.

“There is, literally, a mountain of evidence of corroborating testimony that tends to connect the defendant to the crime,” Mr. Steinglass said during his closing argument on Tuesday. “It’s difficult to conceive of a case with more corroboration than this one.”

Mr. Bragg’s prosecutors kicked off the testimony on April 22 by calling David Pecker, the former publisher of The National Enquirer and a friend of Mr. Trump, to the witness stand. Mr. Pecker spent days testifying to the bigger picture prosecutors were trying to convey: Mr. Trump’s scheme to influence the outcome of the 2016 election.

Prosecutors described for the jurors the now infamous 2015 meeting in Trump Tower where Mr. Trump and members of his inner circle devised a plot to protect his first presidential campaign. Jurors heard compelling testimony from Mr. Pecker about the scandalous stories he purchased and buried to prevent embarrassment to the Trump campaign, a practice prosecutors referred to as “catch-and-kill.”

While the jurors heard that practice was common in the supermarket tabloid world, prosecutors elicited testimony from Mr. Pecker about how his scheme with Mr. Trump — designed to aid his campaign and influence the election — was extraordinary.

From there, prosecutors methodically revealed the crux of their case: the $130,000 hush-money payment from Mr. Cohen to Ms. Daniels to cover up a sex scandal and the reimbursements to Mr. Cohen that resulted in the fake records.

Hope Hicks, Mr. Trump’s former campaign spokeswoman, described the panic in the Trump campaign just before the 2016 election, following the release of the “Access Hollywood” tape, in which Mr. Trump was caught speaking in vulgar terms about women . Keith Davidson, Ms. Daniels’s former lawyer, described how he capitalized on that concern and negotiated with Mr. Cohen to get the hush-money deal for Ms. Daniels. And Jeffrey McConney, the former Trump Organization controller and longtime loyal employee of Mr. Trump, testified about the reimbursement payments to Mr. Cohen.

Other former and current employees followed suit, slowly explained the accounting minutiae and the path of Mr. Cohen’s reimbursements with checks making their way to Mr. Trump in the Oval Office.

Prosecutors corroborated weeks of testimony with documents, recordings, emails, social media posts, phone records and text messages. Notably, jurors saw — several times — a handwritten note from the former Trump Organization chief financial officer Allen H. Weisselberg reflecting the details of the repayment plan to Mr. Cohen (which Mr. Steinglass referred to as a “smoking gun”), and heard conversations that Mr. Cohen recorded that demonstrated Mr. Trump’s knowledge of the hush-money deal.

By reading passages of Mr. Trump’s books, prosecutors depicted the former president as a frugal micromanager who always questioned his invoices, distrusted his employees and had a penchant for revenge. Because Mr. Trump decided not to take the stand in his own defense, this image was never rebutted.

By the time Ms. Daniels and Mr. Cohen were called to the witness stand, they needed only to fill in the gaps.

Ms. Daniels painted a vivid picture of what Mr. Trump was trying to hide from voters: a consensual yet uncomfortable sexual encounter in 2006 in a Lake Tahoe, Nev., hotel room, where Ms. Daniels said there was a power “imbalance” between her and Mr. Trump.

Prosecutors portrayed Mr. Cohen as “the ultimate insider” to Mr. Trump and a “tour guide through the physical evidence.” Mr. Cohen described Mr. Trump’s directive to pay off Ms. Daniels (“Just do it,” Mr. Cohen recalled Mr. Trump’s saying) and their meeting in the Oval Office where Mr. Trump confirmed the plan to reimburse him.

Prosecutors were also helped by Mr. Trump’s lawyers’ decision to call to the stand Robert J. Costello, once Mr. Cohen’s informal legal adviser. One of the defense’s two witnesses, Mr. Costello was uneven and irascible on the stand. Outside the presence of the jury, the judge called him “contemptuous.”

In an intense cross-examination, prosecutors portrayed Mr. Costello as an agent of Mr. Trump who tried to prevent Mr. Cohen from cooperating with law enforcement.

It effectively closed the loop on prosecutors’ narrative of Mr. Trump’s conduct. “The name of the game was concealment,” Mr. Steinglass said in his closing argument, “and all roads lead inescapably to the man who benefited most, the defendant, former President Donald Trump.”

Kate Christobek is a reporter covering the civil and criminal cases against former president Donald J. Trump for The Times. More about Kate Christobek

Our Coverage of the Trump Hush-Money Trial

Guilty Verdict : Donald Trump was convicted on all 34 counts  of falsifying records to cover up a sex scandal that threatened his bid for the White House in 2016, making him the first American president to be declared a felon .

What Happens Next: Trump’s sentencing hearing on July 11 will trigger a long and winding appeals process , though he has few ways to overturn the decision .

Reactions: Trump’s conviction reverberated quickly across the country  and around the world . Here’s what voters , New Yorkers , Republicans , Trump supporters  and President Biden  had to say.

The Presidential Race : The political fallout of Trump’s conviction is far from certain , but the verdict will test America’s traditions, legal institutions and ability to hold an election under historic partisan tension .

Making the Case: Over six weeks and the testimony of 20 witnesses, the Manhattan district attorney’s office wove a sprawling story  of election interference and falsified business records.

Legal Luck Runs Out: The four criminal cases that threatened Trump’s freedom had been stumbling along, pleasing his advisers. Then his good fortune expired .

How to Code for Telehealth, 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.

Looking for additional telemedicine coding resources?

Coding for Telehealth Visits

Note:  These tables are informational, not advisory. The AAFP recommends that physicians verify each payer's policy and ask patients to verify their coverage ahead of appointments. 

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

* Elevance's  policies vary by state; contact your provider-relations representative.

Coding for Audio-only Visits

How do i code an audio-only visit for a new or established patient .

CPT Codes: 99441-99443 

Audio-only scenario notes 

Medicare requires audio-video for most office visit evaluation and management (E/M) services (CPT codes 99202-99215) telehealth services. Audio-only encounters are allowed for certain services. Eligible services may be found on the Medicare Telehealth Services list. Medicare allows audio-only telehealth services for office visit E/M services (CPT codes 99202-99215) for the treatment of mental health conditions.   

UHC states they will consider payment for eligible audio-only services listed in Appendix P of the CPT book. Eligible services must be reported using either POS 02 or 10 and include the -93 modifier. CPT codes billed with modifier -93 that are not in Appendix P will not be considered for payment.   

Private payers vary on covered telehealth services. Check with your provider relations representatives for each payer’s telehealth policy and covered telehealth services. 

CMS will cover telephone evaluation and management (E/M) services (CPT codes 99441-99443) through the end of calendar year 2023. Other services that may be provided via audio-only are available on the Medicare Telehealth List. 

Telephone E/M services are provided to a patient, parent, or guardian and do not originate from a related E/M service within the previous seven days and do not lead to an E/M service or procedure within the next 24 hours or soonest available appointment. 

The following codes may be used by physicians or other qualified health professionals who may report E/M services: 

• 99441: telephone E/M service; 5-10 minutes of medical discussion 
• 99442: telephone E/M service; 11-20 minutes of medical discussion 
• 99443: telephone E/M service, 21-30 minutes of medical discussion 

Telephone E/M services should not be reported when the time spent on the telephone is captured in other services reported, such as: 

• if CPT codes 99421-99423 have been reported by the same physician in the previous seven days for the same problem, 
• when CPT codes 99339-99340 and 99374-99380 are used for the same call, 
• during the same month with CPT codes 99487 and 99489, and 
• when performed during the same service period at CPT codes 99495-99496. 
• Self-funded plans can develop their own policies and may opt out of some cost-sharing waivers. Similarly, Medicaid policies are established at the state-level. The AAFP recommends reaching out to your provider relations representatives or Medicare Administrative Contractors (MACs) to verify policies.  

Coding for Virtual-Digital Visits 

How do i code an e-visit (cpt 99421-99423) for an established patient .

CPT Codes: 99421-99423 

How do I code a virtual check-in (HCPCS codes G2012 and G2010) for an established patient? 

HCPCS Codes: G2012, G2252, G2010 

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. 
• 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: 

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

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