What is the CPT Code for a Telehealth Visit?

Understanding CPT codes for telehealth is essential for healthcare providers and billing professionals. Proper coding ensures accurate reimbursement, maintains compliance with insurance requirements, and supports the growing shift toward virtual care delivery. The Centers for Medicare & Medicaid Services (CMS) established specific codes to differentiate telehealth services from in-person visits, allowing providers to bill appropriately for remote consultations.

What are the specific CPT codes used for telehealth visits?

The primary telehealth CPT codes are 99441, 99442, and 99443, which are specifically designated for synchronous, real-time interactive communication between provider and patient. These codes apply exclusively to established patients and cover both video and phone consultations. Additionally, providers can use standard office visit codes (99202-99215) with the -95 modifier appended to indicate a telehealth delivery method. The choice between these code sets depends on patient status and practice preference.

How do telehealth CPT codes differ between new and established patients?

New patient telehealth visits must use the office visit codes with the -95 modifier because CPT codes 99441-99443 are restricted to established patients only. Established patients, defined as those seen within the past three years, have the flexibility to use either the dedicated telehealth codes or the modified office visit codes. This distinction affects reimbursement, as the 99441-99443 series typically pays 20-30% less than corresponding in-person visits.

What is the -95 modifier and when is it used for telehealth?

The -95 modifier, also known as the “synchronous telemedicine service” modifier, is appended to standard office visit codes to denote that the service was delivered remotely via real-time video or phone communication. This modifier must be used when billing codes 99202-99215 for telehealth visits. It helps insurers and CMS track telehealth utilization and ensures proper reimbursement classification. When using the -95 modifier, documentation must clearly indicate the synchronous nature of the interaction.

What are the time requirements for different telehealth CPT codes?

Time-based billing is critical for telehealth codes. CPT 99441 is appropriate for brief consultations lasting 5-10 minutes, 99442 for moderate visits of 11-20 minutes, and 99443 for longer consultations spanning 21-30 minutes. The time recorded should reflect the actual synchronous interaction between provider and patient. Documentation must support the time claimed, including start and end times of the encounter. For visits exceeding 30 minutes, providers should use the office visit codes with the -95 modifier instead.

Are there different CPT codes for telehealth video visits versus phone consultations?

The CPT codes 99441-99443 apply equally to both video and phone consultations, making them modality-agnostic. However, it’s important to distinguish between synchronous telehealth visits (real-time interaction) and asynchronous services like remote patient monitoring. Codes 99457-99458 cover remote therapeutic monitoring and require specific documentation. When billing for telehealth controlled substance prescribing, providers must ensure the code selected matches the service type and compliance requirements.

How do insurance companies reimburse telehealth CPT codes?

Telehealth reimbursement varies significantly across insurance carriers and states. While historically telehealth codes paid less than in-person equivalents, many major insurers and state Medicaid programs have adopted parity pricing policies. CMS has expanded telehealth coverage significantly. Providers should verify their specific payer contracts to understand reimbursement rates and any geographic or patient population limitations that may apply to telehealth billing.

Frequently Asked Questions

What documentation is required when billing telehealth CPT codes?

Comprehensive documentation is essential for telehealth billing compliance. Records should include the date and time of the visit, duration of synchronous interaction, technology used, patient and provider locations, clinical findings, assessment, and plan. Many payers require attestation that the patient was located in an appropriate setting for the telehealth visit. This documentation supports medical necessity and protects against audit denials.

Can I use CPT codes 99441-99443 for new patient telehealth visits?

The established patient restriction on codes 99441-99443 is a key billing rule. New patients are defined as those without any professional service from the provider or group within the past three years. Using these codes inappropriately for new patients can result in claim denials and potential compliance issues. Always verify patient status before selecting the appropriate code set.

How does healthcare technology regulation affect telehealth CPT code billing?

Regulatory compliance directly impacts telehealth billing. Providers must ensure their telehealth platform meets HIPAA requirements and state-specific regulations. Some states require patient consent forms, and certain specialties may have additional restrictions. Documentation of regulatory compliance strengthens billing claims and protects practices from audit exposure.