Can you bill 99213 and 99455 together?
Asked by: Christophe Runte MD | Last update: December 15, 2025Score: 4.9/5 (43 votes)
Can you bill telehealth and office visit on same day?
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.
Can you bill a well visit and sick visit at the same time?
In fact, it will get easier to bill a well and sick visit together if the situation arises. That's because, unless you opt for coding the sick visit by time, “the sick portion of the visit will be based strictly on MDM, and history and exam will no longer be factors in determining the level billed,” Holle notes.
What are CPT 99455 billing guidelines?
99455 Work related or medical disability examination $278.28 by the treating physician that includes: completion of a medical history commensurate with the patient's condition; performance of an examination commensurate with the patient's condition; formulation of a diagnosis, assessment of capabilities and stability, ...
Can you bill for two CPT codes at the same time?
There is a myth that exists that you can't bill 2 CPT codes during the same 15-minute time period. Well, that myth is only partially true. It is possible to bill 2 CPT codes during the same 15-minute time period.
Medical Coding 99213 vs 99214 - MDM Medical Decision Making Explained
Can you bill a procedure and office visit together?
The immediately preceding evaluation that leads to the recommendation of an office procedure can be billed on the same day as the procedure itself. Similarly, counseling and MDM that arise from the results of a procedure may take place immediately following it and are separately billable.
Can you bill a 99214 and 99401 together?
Yes, you can bill CPT 99214 and 99401 together, provided that the services rendered meet the criteria for each code. CPT 99401 should be utilized for preventive counseling specifically related to obesity management, while CPT 99214 covers the office visit with moderate medical decision-making.
Can 99213 and 99455 be billed together?
Can I code 99455 for a work-related or medical disability evaluation as well as a regular office-visit code (such as 99213) for the same encounter, if it's appropriate? Yes. Code 99455 is one of three used to report evaluations required for life or disability insurance certificates.
What is the CPT code for existing patient office visit?
CPT® code 99212: Established patient office visit, 10-19 minutes | American Medical Association.
Can 2 office visits be billed same day?
Yes, in some cases, you can bill two E&M (Evaluation and Management) codes for the same patient on the same day, but it depends on payer rules and documentation requirements.
What is CPT code 99213 for?
CPT® code 99213: Established patient office visit, 20-29 minutes | American Medical Association.
What is a 25 modifier used for in medical billing?
Modifier 25 is used to indicate that a patient's condition required a significant, separately identifiable evaluation and management (E/M) service above and beyond that associated with another procedure or service being reported by the same physician or other qualified health care professional (QHP) on the same date.
Can you bill 99213 for telehealth visit?
During the COVID-19 public health emergency, many physiatrists are performing standard office visits via telehealth. These services should be billed using standard E/M codes. For example, a level 3 office visit provided to an established patient via telehealth should be billed using code 99213.
What is the 7 day rule for telehealth?
If within 7 days of the initial patient-initiated contact a separate E/M visit (in person or synchronous telemedicine) occurs, then the Online Digital visit is not billed but the time is incorporated into the subsequent E/M visit.
Are telehealth visits billed differently?
Medi-Cal pays the same rate for professional medical services provided by telehealth as it pays for services provided in-person. Please see the Payments and Claims section on this page.
What is CPT code 99495 billing guidelines?
For 99495, the face-to-face visit must occur within 14 calendar days of the date of discharge and medical decision-making must be of at least moderate complexity. Medical decision-making is defined by the E/M Services Guidelines.
Does 99213 need a modifier?
Modifiers may be necessary for CPT code 99213 under certain circumstances, such as when billing for telehealth services or when other procedures are performed on the same day (e.g. Modifier 25). The specific modifier depends on the situation and payer requirements.
Can a nurse practitioner bill a 99213?
It is generally considered to be a moderate-length visit that involves a comprehensive assessment and treatment plan. The 99213 code is used by a wide range of healthcare professionals, including physicians, nurse practitioners, and physician assistants.
Can you bill a preventive visit with an office visit?
Physicians are not prohibited from coding and billing for both preventive and problem-focused E/M services when they are performed during the same appointment.
Can you bill an office visit and hospital visit on the same day?
CPT Codes 99221-99223, 99231-99236, 99238 & 99239
MACs pay both visits if you see a patient in the office on 1 day, and they're admitted to the hospital as an inpatient or get observation care on the next day.
What is the 33 modifier used for?
Current Procedural Terminology (CPT) modifier 33 can be used when billing for ACA-designated preventive services with a commercial payer. The addition of modifier 33 communicates to a commercial payer that a given service was provided as an ACA preventive service.
Can you bill a 99214 for telephone visit?
For the duration of the public health emergency, CMS and some private payers are allowing audio-only telephone calls to be billed in the same way as in-person visits and these visits will be paid in equivalent amounts as E&M codes 99212-99214.