cpt for home visit 2022

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Understanding the long list of prolonged services in 2022 and beyond

April 22, 2022 | By Grant Huang , CPMA, CPC

Prolonged services have been around for a long time – no pun intended – but in recent years the number of codes involved has grown and their requirements have changed, making them a potentially risky area for providers. For this reason, auditors should take the time to brush up on the types of prolonged services there are to choose from. In this tip, we will do just that.

Before we dive in, it’s worth nothing that prolonged services have appeared more than once on the list of audit targets pursued by the HHS Office of Inspector General (OIG). “The necessity of prolonged services are considered to be rare and unusual,” the agency has opined in one of its past targeting memos . “We will determine whether Medicare payments to physicians for prolonged E/M services were reasonable and made in accordance with Medicare requirements.”

The OIG was referring specifically to the add-on codes associated with office/outpatient E/M codes 99202-99215, but in 2022 and beyond we have to contend with significant changes to some existing prolonged services codes as well as new add-on codes to be used with 99202-99215. Please refer to the table below for a complete list.

Breaking down the prolonged services codes:

• +99417 and +G2212. These are the two codes likely to come up most frequently on audits for prolonged E/M services. Add-on code +99417 was created by CPT and relies on either 99215 or 99205 as the primary code. It becomes billable exactly one minute after the time threshold for 99215 or 99205 is exceeded – thus to take 99205 as an example, one unit of +99417 is billable at 75 minutes. The 99205 accounts for the first 74 minutes. This is different from how +G2212 works; +G2212 was established by CMS and is used by Medicare payers, though not exclusively. Some commercial payers are accepting +G2212 instead of +99417. This may be because +G2212 cannot be billed until 15 minutes past the time threshold for 99215 or 99205. Again, taking 99205 as an example, +G2212 becomes billable only 15 minutes after the first 74 minutes covered by 99205 – starting at 89 minutes. Effectively, the use of +G2212 tacks 15 minutes of additional time onto 99215 and 99205 and saves payers that 15 minutes of prolonged service time. While both codes are billed at one unit per 15-minute time block, it’s important to verify payer policies on which code to use. Remember that these prolonged services include non-face-to-face time spent before or after the direct patient care if those times can be directly attributed to the patient encounter. This is one reason why I expect the OIG to be taking a close look at utilization of these two codes going forward, when providers can count such activities as “time spent documenting in the EHR” after the patient is gone, towards the E/M service’s total time.
• +99415 and +99416. Introduced in 2016, these codes are used with office/outpatient E/M codes but are not limited to the level 5 codes only. There were revised in 2021 to clarify that they are no longer used with the older prolonged service codes 99354 and +99355. +99415 and +99416 describe prolonged service time spent by clinical staff during an E/M visit with direct patient contact. Rather than being reported as one unit per 15-minute block of time, +99415 is reported to cover up to the first 60 minutes of time after the “highest time in the range of total time” of the E/M service, according to CPT guidelines. This follows the logic CPT uses for +99417. For each additional time block of up to 30 minutes, a unit of +99416 is supported. Remember that the CPT guidelines state the clinical staff should be spending the time in direct patient contact under physician supervision.
• 99354 and +99355. Prior to 2021, these codes were used in conjunction with office/outpatient E/M codes when prolonged time thresholds were met. After 2021, that function was transferred to the newly implemented add-on codes +99417 and +G2212 (as well as +99415 and +99416 for clinical staff time. This leaves +99354 and +99355 fairly limited usage options, such as outpatient consultation codes 99241-99245 for those commercial payers still reimbursing these codes, and then a variety of less frequently utilized outpatient codes. These include psychotherapy services (90837, 90847), domiciliary/rest home visits (99324-99337), home visits (99341-99350), and care planning services for cognitively impaired patients (99483).
• 99356 and +99357. These codes are the inpatient/observation setting counterparts to 99354 and +99355. They were revised in 2021 to account for the implementation of +99417 and +G2212, and the resulting changes to 99354 and +99355. 99356 and +99357 cover the total time spent by a physician or other provider at the patient’s bedside as well as on the patient’s floor or unit in the hospital or nursing facility, that exceeds the time threshold of the primary code (such as initial or subsequent hospital care). Note that the time spent on the date of service does not have to be continuous.
• 99358 and +99359. These codes cover prolonged service time that does not involve direct patient contact, but was instead spent either before or after face-to-face patient contact. They were revised slightly to spell out that they are not to be used with 99202-99215. Remember that part of the 2021 CPT changes to codes 99202-99215 include new language stating that when these services are reported based on the provider’s time spent on the date of service, time before and after direct patient contact can be included.

Prolonged services have been an audit target for years, and Medicare and commercial payers have struggled to balance the need to reimburse encounters that take much longer than usual with the need to prevent fraud and abuse. Given the recent changes in 2021 to the office/outpatient E/M codes and their accompanying prolonged service codes, it’s a sure bet that payers will be scrutinizing utilization for any increases and conducting audits to ensure compliance with guidelines. Physicians looking to ensure that they are being properly reimbursed often ask me about prolonged services in case they are leaving “money on the table,” and it’s more important than ever to make sure that auditors have the answers ready.

Related posts

Home Health Coding Updates You Should Know

A good patient outcome is the direct result of a good plan of care. This plan is only beneficial if it is developed around confirmed patient diagnoses.

Complete and accurate coding of patient diagnoses is the foundation for care provided and directs the clinician to prevent any negative events and achieve the desired results. Recent coding changes need to be included for timely, accurate reimbursement.

Important Home Health Coding Process Change

The 2022 Official Guidelines , also known as the documentation guidelines, had no coding convention changes. However, beginning in April 2022 the Centers for Disease Control and Prevention (CDC) will implement a bi-annual update to the coding process . Codes will now be updated in October, as usual, and in April as well.

There will be a phased-in approach to ease the strain of two updates a year, but the overall process will remain the same.

2022 Home Health ICD-10-CM Diagnosis Codes

The CDC has added 159 new diagnosis codes that went into effect October 1, 2021.

Here are the other changes to ICD-10-CM codes:

• Revised 22 diagnosis codes
• Deleted 32 diagnosis codes
• Diagnosis description revisions for 42 diagnosis codes
• Added three diagnosis codes
• Removed six codes
• Identified 135 diagnosis codes as “Code First” as a reference

In addition to new codes, clinical grouping assignments have also been altered.

How Grouping Changes Affect Comorbidity Adjustments

The primary clinical groupings these new codes fall under have been released, but how the low or high comorbidity adjustments will affect these codes is not known until the 2022 Home Health Final Rule is enacted in January 2022.

As currently proposed, there are 20 new low comorbidity adjustments and 85 high comorbidity adjustments.

Under the Patient-Driven Groupings Model (PDGM) , a patient’s primary diagnosis determines their clinical grouping. The secondary diagnoses may result in a comorbidity adjustment to their 30-day period, and result in higher reimbursement due to the increase resources that may be needed. Utilizing no secondary diagnoses will be result in no comorbidity adjustment, a single secondary diagnosis may fall under low comorbidity adjustment, while two or more secondary diagnoses that interact with each other will result in the high comorbidity adjustment.

Because 30-day periods are influenced by a comorbidity adjustment, proper documentation and coding of all comorbidities is essential for correct reimbursements and improved patient outcomes.

For more in-depth information on the 2022 diagnosis codes and coding examples to understand, watch this webinar .

Axxess Home Health , a cloud-based home health software, includes updated diagnosis codes built into the software for easy documentation and accurate coding.

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Billing and Coding for Physician Home Visits

by Rajeev Rajagopal | Posted: May 23, 2018 | Medical Coding

Physician home visits have begun making a comeback, according to a recent report from the Association of American Medical Colleges (AAMC). With 80% of U.S. adults age 65+ having one or more chronic diseases, this is a welcome development. Point of care testing along with advancements in home health technology and support have improved the physician’s ability to cater to the needs of older weak patients with multiple comorbidities outside the office setting. Outsourcing medical coding can ensure accurate claim submission for optimal reimbursement for services provided. However, to qualify for coverage, the medical record must document the medical necessity of the home visit made in lieu of an office or outpatient visit. The Office of Inspector General (OIG) and several contractors of the Centers for Medicare & Medicaid Services (CMS) scrutinize physician home services billed to the Medicare program to ensure that house calls are medically necessary and not for the convenience of the patient, the patient’s family, or the physician (or provider).

Don’t let complex billing and coding processes hold you back from providing quality patient care.

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Physician Home Visits must be “Medically Necessary”

Medicare.gov defines “medically necessary” as “health-care services or supplies needed to prevent, diagnose, or treat an illness, injury, condition, disease, or it’s symptoms and that meet accepted standards of medicine”.

CPT codes 99341 through 99350, Home Services codes, are used to report E/M services provided to a patient residing in his or her own private residence and not any type of facility. According to a 2017 AAPC report:

• For home visits to qualify as medically necessary, providers need to document if the home visit is based upon a one-time need, or if the visit is provided to meet an ongoing or permanent need because of the patient’s physical, medical, mental, or psychological issues.
• The physician should provide proof that the patient is not physically capable of traveling to the office either this one time, or on an ongoing basis, due to physical or mental issues and not due to financial or other personal reasons.
• Home services cannot be provided at the physician’s convenience (for e.g., visiting senior independent living facilities on a routine basis, without requests for or by patients).
• Under Medicare’s home health benefit, the beneficiary must be confined to the home for services to be covered.
• For home services provided by a physician billed under CPT codes 99341 through 99350, the beneficiary does not need to be confined to the home.

CGS Adminstrators, LCC points out that if the physician visits the patient in his/her home on a regular basis, each note should show how the patient’s condition has changed. Providers should take care to avoid cloned or copied documentation that does not explain how the patient’s condition has improved or deteriorated.

Home Services CPT Code Range 99341- 99350

Codes 99341-99350 report evaluation and management (E/M) services provided in a private residence (place of service 12) and cannot be used if the patient resides in a shared living facility or group home. The description of home visits includes the average time to be used when counseling/coordination of care dominate the visit (for e.g., comprises over 50 percent of total face-to-face time between the provider and patient).

Codes for New Patients

99341 Home visit; low severity problem, 20 min. 99342 moderate severity problem, 30 min. 99343 moderate to high severity problem, 45 min. 99344 high severity problem, 60 min. 99345 patient unstable or significant new problem requiring immediate attention 75 min.

Codes for Established Patients

93347 Self-limited or minor problem, 15 min. 99348 Low to moderate problem, 25 min. 99349 Moderate to high problem, 40 min. 99350 Patient unstable or significant new problem requiring immediate physician attention, 60 min.

If other services such as advanced care planning, diagnostic services, and some minor procedures are performed, they can be documented and billed in addition to the visit code in this setting.

Demographics, Insurance, and Billing Information

As the home visit with a new patient has the same business requirements as a visit to the office, AAPC says that maintaining a complete and accurate medical record for each patient is critical. Physicians should gather the necessary demographic and insurance information and provide patients with the appropriate forms such as Notice of Privacy Practices, general consent for treatment, new patient intake form, history form, and financial policies.

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Billing for Physician Home Visits – Risk Factors

DC based Law Firm Liles Parker lists the risk factors that can lead Medicare reviewers to deny claim payment:

• If it appears that one or more of the home services were was conducted for the convenience of the patient, the patient’s family, or the physician
• The documentation does not prove that the patient was not able come to the physician’s office or an outpatient clinic for care.
• The medical record does not clearly show that the patient, his/her family or another clinician involved in the case sought the initial service
• The home services are provided at a frequency that exceeds that which is typically provided in the office and acceptable standards of medical practice
• The physician does not personally provide the home services. The service is performed by a non-physician practitioner (NPP) but the claim is being billed at the physician’s rate.
• The home services are solely provided by an NPP but only the physician, not the treating NPP, is credentialed with Medicare.
• The specific home services performed could be provided by a visiting nurse or home health agency.

With OIG and many CMS contractors auditing home services (CPT codes 99341 through 99350) billed to Medicare, participating physicians should understand the coverage and billing requirements. The documentation should provide clear proof of medical necessity. Other services such as minor procedures or advanced care planning services can also be rendered in a variety of living situations and providers should be familiar with the specifics to each code location. It is important that physicians review all the relevant CPT codes with their medical billing company . Partnering with an experienced medical billing and coding service provider can help home-based primary care practices achieve savings while delivering holistic, team-based care to old, sick, frail, or functionally limited people.

Rajeev Rajagopal, the President of OSI, has a wealth of experience as a healthcare business consultant in the United States. He has a keen understanding of current medical billing and coding standards. More from This Author

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CPT Code For Home Visit

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How to bill for a house call visit.

House doctors are returning because there are clear benefits to patients. Physicians on telehealth should be aware of certain refundable fees and other considerations. How are CPT codes used for billing home visit visits?

These codes apply to evaluation and management (E/M) services provided in a patient's home. “Home” can include a private residence, temporary lodging, or short-term accommodation. New patient CPT codes 99341 – Home visit for the evaluation and management of a new patient. This visit requires the following three components.

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Home and Domiciliary Visits

In a case like this, a doctor may oversee and direct progressively better advanced assessment and control (E/M) visits in the home. Those efforts will help improve home healthcare. A provider is a presence that offers face-on service. This cannot be confused with the home care incidents service. Please find out more here.

If a beneficiary is receiving care under home health benefit, primary treating physician will be working in concert with home health agency Documentation which Supports Home Visits A home visit must be reasonable and necessary, not a convenience.

Senior independent living facilities

Home services cannot be provided at the physician's convenience visiting senior independent living facilities on a routine basis, without requests for or by patients. Under Medicare's home health benefit , the beneficiary must be confined to the home for services to be covered.

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House Calls are Back!

Recently, we have heard about more nurses and physicians looking for ways to develop a more personalized care approach that allows for more intimate contact with patients. House call practices have remained popular despite the absence of a new concept. Do I want to start my own practice? It should be obvious that health care reimbursements are not constructed in this way.

For someone who's unable to fully perform those activities without help Residential Substance Abuse Facility - A facility which provides treatment for substance (alcohol and drug) abuse to live-in residents Place of Service (POS) Codes 12 - Home 13 - Assisted Living Facility.

CPT Codes and Reimbursement for House Call Services

CPT codes have limited limitations: The clinician who performs house calls must pay for these codes. This CPT code applies to services in evaluation or management (“E/M”). The home may include a private home, temporary accommodation. Below is some information about available requirements for codes.

Outsourcing medical coding can ensure accurate claim submission for optimal reimbursement for services provided. However, to qualify for coverage, the medical record must document the medical necessity of the home visit made in lieu of an office or outpatient visit.

CPT Home Services Codes

Physicians use a few CPT codes when billing home calls. This code is applicable to the evaluation and management services provided on the patient premises. “Home” includes rental accommodation or temporary residence and temporary housing.

Codes for Established Patients 93347 Self-limited or minor problem, 15 min. 99348 Low to moderate problem, 25 min. 99349 Moderate to high problem, 40 min. 99350 Patient unstable or significant new problem requiring immediate physician attention, 60 min. If other services such as advanced care planning, diagnostic services, and some minor procedures are performed, they can be documented and billed in addition to the visit code in this setting.

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New patient CPT codes

99341 – Home visits are made to evaluate and treat new patients. This visit requires these three components. In general problems presented have a low severity. The doctors usually meet with patients and their families in 20 minutes.

• 99442 – Like above but it is a very serious problem that takes around 30 minutes to resolve.
• 99344 – Moderate or extremely severe issue requiring 30 minutes.

CPT Code 99341

Home visits for evaluation and treatment of new patients require 3 components. Counseling and/or coordination of care with other medical specialists or agencies is done in accordance with the nature and needs of the client and family. Generally present problems have low severity. In general, the patient will spend 20 minutes in person.

Get the details you need on CPT code 99341, which is used for office or other outpatient visits for established patients. Learn about its reimbursement rate and what services are included in this code. Find out how to submit claims correctly for maximum reimbursement today.

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What is procedure code 99348?

CPT code 99348 A house inspection to assess or manage a well-established patient requires a minimum of 2 of those 3 key elements: A longer problem-focused time history; A longer problem-focused inspection. Medical decisions are simple and straightforward.

Get to know procedure code 99348 - an evaluation and management service for an established patient with a low-to-moderate complexity medical problem. Learn more about the rules, reimbursement rates, and other important information regarding procedure code 99348.

CPT Code 99348 Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; and Medical decision making of low complexity.

What does CPT code 99337 mean?

CPT code 99337 reflects the home visits or domiciliaries for E/M of a well established patient. This includes a complete interval record and a complete interval history. The full exam is here. Medicine decisions vary in difficulty.

The medical record does not clearly show that the patient, his/her family or another clinician involved in the case sought the initial service The home services are provided at a frequency that exceeds that which is typically provided in the office and acceptable standards of medical practice The physician does not personally provide the home services.

What is CPT code 99326?

The doctor's visit to a dociliary or hospital home for evaluation and management of a young person is required to provide a thorough history and medical decisions that can take some time.

CPT code 99326 is a medical billing code for a home visit by an established patient. It is typically used for follow-up visits to monitor and manage chronic conditions or provide preventive care services. Learn more about CPT code 99326.

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What does CPT code 99384 mean?

99384- Initial comprehensive preventive medicine assessment and treatment for individuals including age and gender appropriate history examination counseling, anticipatory guidance, risk factor reduction intervention.

Your documentation should prove that the patient is not physically capable of traveling to the office. You may base this assessment on physical or mental issue s, not financial or personal matters. You can't provide home services for your convenience as the physician. Patients receiving care under Medicare's home health benefit must be confined to the home.

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Freed American Paul Whelan thanks lawmakers for bringing him home during Capitol Hill visit

Whelan shared his gratitude at an event at the Capitol.

Against the backdrop of the U.S. Capitol at dusk, freed American Paul Whelan, who just completed a government resettlement program in Texas following his return from wrongful detainment in Russia, thanked the lawmakers who worked to help secure his release.

Whelan praised a "bipartisan effort that brought me home" after spending the day meeting with lawmakers who took up his case from his home state of Michigan and elsewhere.

"The Michigan delegation brought me home here," he said.

"You know, it was five years, seven months and five days," he added of his time in Russian custody. "I counted each one of them."

RELATED: Timeline of Evan Gershkovich's and Paul Whelan's detainment in Russia

The former Marine revealed he spent the final five days in the Russian prison in solitary confinement.

"I couldn't leave my cell," he said, "but I made it home."

Whelan wouldn't preview what's next for him -- offering only that he needs a new car and that suddenly he's in a place with electric and driverless vehicles -- but said he's involved in discussions over how to support other wrongfully detained Americans around the world.

"We're coming for you," Whelan said to those Americans. "The United States is not going to let people like me, Marc (Fogel), Trevor (Reed), Brittney (Griner, who was released in December 2022) languish in foreign prisons. It might take time, but we're coming for them and everybody else."

Whelan acknowledged the reporters he recognized by name or face, recalling the precise month he spoke with them via a smuggled phone from prison. He thanked them for reporting on his case.

RELATED: Why were Evan Gershkovich, Paul Whelan and others being held prisoner in Russia?

He also thanked "all of the people that work for agencies that I will never meet, people that I will never know, their staff members, everyone that's been involved at every level."

Rep. Haley Stevens, who represents Whelan's district in Congress, told ABC News she expects to lean on him for the complex policymaking to mitigate foreign detentions like his.

"Well, he might not know it, but I plan to be in touch with him for a very long time to come, as long as he'll welcome it, because there's a lot to learn from his experience," she said.

She noted that Whelan's case was "the first one" of a series of high-profile detentions in Russia, including Griner and Evan Gershkovich, and it "certainly changed the relationship that the United States had with Russia, even before the war in Ukraine began."

"Our message to Russia is that when it comes to your shenanigans and your illegal and unjust and unlawful behavior, we, as the United States of America, are united. We will fight for our people," she said. "We will bring them home, and we will win."

Whelan returned to the United States on Aug. 2 after five and a half years in a Russian penal colony.

Russian authorities released Whelan, as well as American journalists Gershkovic and Alsu Kurmasheva, in a multi-country deal that freed eight Russian prisoners abroad. The 26-person swap was the largest between the U.S. and Russia since the Cold War.

Whelan was arrested in Moscow in 2019 on charges of espionage and sentenced to 16 years in prison. Whelan, who frequently visited the city, was deemed as wrongfully detained by the U.S. Department of State.

The former Marine wasn't the only former Russian captive on Capitol Hill Tuesday. Vladimir Kara-Murza, a dual Russian-British national whose release was secured by the U.S., met with lawmakers. Kara-Murza was imprisoned in Russia for two years for his opposition to Vladimir Putin's war in Ukraine.

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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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