Can you bill a 99213 for telemedicine?
Asked by: Frederic Herzog | Last update: November 20, 2025Score: 4.1/5 (55 votes)
What is the CPT code 99213 for telemedicine?
CPT® code 99213: Established patient office or other outpatient visit, 20-29 minutes. As the authority on the CPT® code set, the AMA is providing the top-searched codes to help remove obstacles and burdens that interfere with patient care.
Can you bill and office visit for a telehealth?
E-Consults: A health care provider at the distant site may bill for an e-consult with the CPT Codes listed in the Medi-Cal Telehealth Provider Manual when the benefits or services delivered meet the procedural definition and components of the CPT code for e-consults as defined by the AMA as well as any requirements ...
Can I bill 99214 for telehealth?
would need to list HCPCS code T1015 in the “payable” claim line in conjunction with one of the appropriate corresponding CPT codes (i.e., 99201-99203 for “new” patients, and 99212-99214 for “established patients) on the “informational” line relative to the complexity of the virtual/telephonic communication.
What are the rules for CPT code 99213?
CPT code 99213 is an evaluation and management (E/M) code for office or other outpatient visits, typically used for established patients who require a low level of medical decision-making (MDM) and management. If choosing the code based on time, the encounter involves 20 or more minutes of total time on the visit date.
Billing for Telemedicine
What is the difference between a 99213 and an 99214?
This code is applied when a patient's care involves moderate complexity, such as managing multiple medical conditions or addressing more serious symptoms. The reimbursement rate for this CPT code is higher than 99213 because it includes face-to-face time spent between patient and physician.
What is an example of a 99213 visit?
An example of a 99203 or 99213 is a sinus infection treated with an antibiotic. Although the prescription makes the risk component moderate, the one acute uncomplicated illness is a low-complexity problem, and there are no data points.
Do you use 95 or GT modifier for telehealth?
The two most commonly used modifiers are the GT modifier for telehealth service rendered via interactive audio and video telecommunications systems, and the 95 modifier for synchronous telemedicine service rendered via a real-time interactive audio and video communications system.
Is telehealth considered outpatient?
Following social distancing guidelines, both large health-care organizations and independent medical practices retooled to deliver outpatient care remotely by using telehealth technology. The technology predominantly used to replace in-person visits was real-time audio and video services.
Which code cannot be reported as a telemedicine code?
99221: This is an initial hospital care service. According to the AMA, this code cannot be used for telemedicine services.
What is the difference between telemedicine and virtual visits?
Key Differences
Telehealth often involves more extensive integration of technology, such as electronic health records and remote monitoring devices, to facilitate comprehensive care delivery. In contrast, virtual visits are more streamlined, with a primary focus on providing immediate medical consultations remotely.
What are two conditions that can be treated using telehealth?
- Cold.
- Skin rashes.
- Headache.
- Sinus infection symptoms.
- Acne.
- Birth control prescriptions.
- Flu symptoms in kids and adults.
What is the E&M code for telemedicine?
99421 (online digital evaluation and management [E/M] service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes) (pays approximately $16) 99422 (11-20 minutes) (pays approximately $31) 99423 (21 or more minutes) (pays approximately $50)
Is 99213 a preventive code?
However, if you bill an additional office visit code (for example, 15 minute expanded problem visit code 99213 with modifier 25), this is NOT considered a preventive service, and may be subject to deductibles, copays or coinsurance.
How do you code telemedicine visits?
- 99202-99205: Office/outpatient E/M visit, new patient.
- 99211-99215: Office/outpatient E/M visit, established patient.
- G0425-G0427: Consultations, emergency department or initial inpatient (Medicare only)
Can you bill a facility fee for telemedicine?
How is the examining room paid for in telehealth? There is no reimbursement specific to exam room expenses; the originating site may submit a claim for facility fee and transmission fees.
What is the CPT code 99213?
CPT 99213 specifically describes a moderate-complexity office or outpatient visit. This code applies only to established patients—those who have previously been seen by the practitioner or another provider within the same group practice within the last three years.
What type of visit is telehealth?
Technologies for telehealth include videoconferencing, store-and-forward imaging, streaming media, and terrestrial and wireless communications. Telehealth services may be billed and paid differently, depending on the payer/insurer you're working with and your geographic location.
What are two modifiers that can be used for billing telehealth?
- -93: Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system.
- -GQ: Telehealth service rendered via asynchronous telecommunications system.
Is modifier 95 required for telehealth services in 2024?
Therapy providers, including SLPs, will continue to use modifier “95” to indicate telehealth services and will not use one of the POS codes for telehealth services, regardless of settings. SLPs should continue to report the POS code that best reflects where services would have been provided in person.
What modifier does Aetna use for telemedicine?
Modifiers GT, 95, FR
When a provider reports modifier GT or 95, it certifies the patient received services via an audiovisual telecommunications system. Click herefor more information about our telemedicine liberalization in response to the Coronavirus COVID-19 outbreak.
When should I use 99213?
Evaluation and Management Codes: New vs Established Clients
Unlike 99212 through 99215, 99202 through 99205 describe newly established clients being seen for evaluation and management services. Code 99213 should only be used with established clients you have already seen for an intake session (CPT Code 90792).
What is the difference between 99213 and 99214 in 2024?
Code 99213 typically represents a visit involving low to moderate complexity and shorter duration, while 99214 indicates a visit with moderate to high complexity and longer duration.