Telehealth through video and phone consultations has become a common alternative to in person care, offering Medicare patients convenient access to a provider from the comfort of their homes. The flexibility and ease of virtual visits have proven invaluable for patients with mobility challenges, those living in rural areas, and anyone seeking timely care without the need for travel. It’s especially helpful for minor concerns and follow ups to in person care.
With Medicare changes for 2025 there are several important updates around billing for telehealth services, which providers should review carefully to maintain compliance and optimize reimbursement. Understanding these updates will help ensure a smooth transition into the new year, safeguarding both patient care continuity and financial stability for medical practices.
Most Common CPT Codes Used for Telehealth and Reimbursed by Medicare
1. CPT Code 99441 – Telephone Evaluation and Management (E/M) Services:
Description: This code is used for telephone consultations between a healthcare provider and a patient.
Service: The phone call is typically a brief consultation to discuss a medical issue or follow-up care.
Time/Duration: It typically applies to phone calls that last 5 to 10 minutes.
Eligible Providers: Physicians or qualified healthcare providers.
Medicare Reimbursement: Medicare will reimburse for this code if the phone consultation is medically necessary and appropriate.
2. CPT Code 99442 – Telephone Evaluation and Management (E/M) Services:
Description: This code is for telephone consultations that are slightly longer or more complex than the ones covered by CPT 99441.
Service: Similar to 99441, but these calls may involve more detailed discussions or coordination of care.
Time/Duration: These calls typically last 11 to 20 minutes.
Eligible Providers: Physicians, nurse practitioners, or other healthcare professionals.
3. CPT Code 99443 – Telephone Evaluation and Management (E/M) Services:
Description: This code is used for longer phone consultations.
Service: These calls can involve more complex management, such as follow-up care or reviewing lab results.
Time/Duration: These calls typically last 21 to 30 minutes.
Eligible Providers: Physicians or qualified healthcare providers.
4. CPT Code 99421, 99422, 99423 – Online Digital E/M Services:
Description: These codes are for non-face-to-face services that involve communication through digital platforms like email or a patient portal, but can sometimes be applicable for phone calls if done through secure messaging platforms.
Service: These codes are used when a patient’s medical issue is addressed via secure electronic communication rather than a traditional phone call, though they can sometimes be billed similarly in cases of remote consultations.
Time/Duration: Time spent on the communication will determine the appropriate level (e.g., 99421 for 5-10 minutes, 99422 for 11-20 minutes, etc.).
99421: 5-10 minutes of online communication.
99422: 11-20 minutes.
99423: 21+ minutes.
Updates to CPT Codes 99441, 99442, and 99443 for 2025 Medicare Reimbursement
As Medicare continues to expand access to telehealth services, there are billing updates for 2025 that require changes to how telephone evaluation and management (E/M) services are covered and reimbursed.
What’s Changing in 2025?
Extended Coverage for Audio-Only Services:
Medicare recognizes that not all patients have access to video-enabled devices or stable internet connections. To address this disparity, audio-only services covered under codes 99441-99443 will continue to be reimbursable for certain patient populations in 2025. This ensures equitable access to care for rural and underserved communities.
Updated Documentation Requirements:
Providers must ensure that telephone E/M services meet updated documentation standards, which include:
- Clear medical necessity for the telephone visit.
- Duration of the call documented.
- Summary of the patient’s concerns and management provided.
Revised Modifiers and Billing Guidelines:
While the CPT codes themselves remain the same, 2025 introduces new modifiers to distinguish between standard telehealth visits and those conducted under special circumstances (e.g., audio-only vs. audio-video services). These modifiers are essential for accurate claims processing and to avoid payment delays.
Based on the 2025 coding guidelines for telehealth in the US, the following code modifiers are used:
Modifier 95: This indicates “Synchronous Telemedicine Service rendered via a Real-Time Interactive Audio and Video Telecommunication System”25. It is used for audio-video telehealth visits.
Modifier 93: This denotes “Synchronous Telemedicine Service rendered via Telephone or Other Real-Time Interactive Audio-only Telecommunication System”. It is used for audio-only telehealth services.
Modifier FQ: This is a Medicare-specific modifier used alongside CPT modifier “93” for audio-only services.
These modifiers are typically appended to the standard Evaluation and Management (E/M) codes (e.g., 99202-99215) when billing for telehealth services.
Additionally, Place of Service (POS) codes are used to indicate the location of the patient during the telehealth service:
POS 02: Used when the patient is not in their home when telehealth services are rendered.
POS 10: Used when the patient is in their home when telehealth services are rendered.
It’s important to note that while new CPT codes for telehealth (98000-98016) were introduced for 2025, Medicare will not recognize most of these codes, with the exception of 98016 for brief virtual check-ins.
Continued Emphasis on Established Patients:
Medicare continues to limit the use of these codes to established patients to promote continuity of care. Providers should confirm patient status before billing under these codes.
Payment Parity with In-Person Visits:
In response to ongoing advocacy, Medicare has maintained payment parity for certain telehealth services, including those billed under codes 99441-99443. This adjustment encourages providers to offer high-quality care regardless of the delivery method.
Why These 2025 Medicare Updates Matter
According to CMS, these changes reflect Medicare’s commitment to patient-centered care and the growing demand for flexible healthcare solutions. By refining the rules for telephone E/M services, Medicare aims to support providers in delivering effective, accessible care while maintaining the integrity of the billing process.
UnisLink Offers Expert Medical Coding and RCM Services
At UnisLink, we understand the complexities of navigating Medicare’s evolving telehealth regulations. Our expert medical billing services are designed to ensure that physicians and healthcare providers receive maximum reimbursement for the services they provide.
With comprehensive knowledge of the latest Medicare updates, including the 2025 changes to telehealth codes and modifiers, our team works to optimize claims processing, minimize denials, and ensure compliance.
Contact us today for a free revenue cycle assessment and discover the gaps in your current RCM that can boost net new cash immediately.
Key Notes:
Medically Necessary: For any phone consultation, Medicare will only reimburse if the consultation is deemed medically necessary. The provider needs to document the medical necessity of the call.
Telehealth Expansion: During the COVID-19 pandemic, Medicare significantly expanded coverage for phone consultations and telehealth services, including audio-only services, and this flexibility has largely remained in effect. This means that even without a video component, Medicare may reimburse for phone calls as long as the service meets the necessary criteria.
Provider Eligibility: The healthcare professional providing the service must be an eligible provider (such as a doctor, nurse practitioner, or clinical psychologist).
Code Selection Based on Time: The reimbursement amount for these codes varies depending on the length of the phone call and the complexity of the medical issue addressed.
Written materials: If written educational materials are provided in conjunction with another reimbursable service (e.g., a counseling or education session), they may be considered part of that service, rather than separately reimbursed.
Documentation: Ensure that any written materials provided to patients are well-documented as part of the broader educational or counseling service