Critical 2025 CPT Updates for Telemedicine Code

Each year, the AMA updates the existing CPT codes used for submitting claims. These changes can include deletions of existing codes, additions of new codes, and modifications to existing code descriptions. For 2025, the AMA has introduced new CPT codes that significantly alter the billing process for telehealth claims.

The new code sets differ according to:

  1. A patient’s status – New versus Established
  2. The type of telehealth utilized – Phone versus Audio/Video
  3. The code level determination – Which can be selected based on time or documentation.

In addition to the new telehealth codes, the AMA has introduced new pain service CPT codes to more accurately document the performance of fascial plane injections.

Check out our overview of the most important CPT code updates of which you should be aware.

Telemedicine codes

  • Audio/Video – New Codes – will replace the current use of E/M office visit cpt codes (99202-99215)
    • 98000 – Synchronous audio-video visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded
    • 98001 – Synchronous audio-video visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded
    • 98002 – Synchronous audio-video visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded
    • 98003 – Synchronous audio-video visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded
    • 98004 – Synchronous audio-video visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 10 minutes must be met or exceeded.
    • 98005 – Synchronous audio-video visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded
    • 98006 – Synchronous audio-video visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded
    • 98007 – Synchronous audio-video visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded
  • Telephone – New Codes – will replace the code 99441-99443 which will be deleted
    • 98008 – Synchronous audio-only visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination, straightforward medical decision making and more than 10 minutes of medical discussion.  When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded
    • 98009 – Synchronous audio-only visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination, low medical decision making and more than 10 minutes of medical discussion.  When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded
    • 98010 – Synchronous audio-only visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination, moderate medical decision making and more than 10 minutes of medical discussion.  When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.  When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded
    • 98011 – Synchronous audio-only visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination, high medical decision making and more than 10 minutes of medical discussion.  When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.  When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded
    • 98012 – Synchronous audio-only visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination, straightforward medical decision making and more than 10 minutes of medical discussion.  When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.  When using total time on the date of the encounter for code selection, 10 minutes must be met or exceeded
    • 98013 – Synchronous audio-only visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination, low medical decision making and more than 10 minutes of medical discussion.  When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.  When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded
    • 98014 – Synchronous audio-only visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination, moderate medical decision making and more than 10 minutes of medical discussion.  When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.  When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded
    • 98015 – Synchronous audio-only visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination, high medical decision making and more than 10 minutes of medical discussion.  When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.  When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded

EXCEPTION-CMS Policy: 

These new codes do not come without some complications.  As has been the case in some prior years with E/M changes, CMS will not recognize or reimburse these new codes and has assigned payment status “I” (not valid for Medicare purposes) for 2025.  Medicare’s policy on telemedicine services will continue to be reporting with the appropriate office E/M code (99202-99215) and POS 02 or 10.  

New Fascial Plane Block CPT Codes

The codes below will replace some instances for which we previously coded 64999.

  • 64466 – Thoracic fascial plane block, unilateral; by injection(s), including imaging guidance, when performed
  • 64467 – Thoracic fascial plane block, unilateral; by continuous infusion(s), including imaging guidance, when performed
  • 64468 – Thoracic fascial plane block, bilateral; by injection(s), including imaging guidance, when performed
  • 64469 – Thoracic fascial plane block, bilateral; by continuous infusion(s), including imaging guidance, when performed
  • 64473 – Lower extremity fascial plane block, unilateral; by injection(s), including imaging guidance, when performed
  • 64474 – Lower extremity fascial plane block, unilateral; by continuous infusion(s), including imaging guidance, when performed

Virtual Check-In

Additionally, a new virtual check-in code 98016 will be available to report an evaluation of whether the patient needs to be seen in person.   

  • 98016 – Brief communication technology-based service (e.g., virtual check-in) by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related evaluation and management service provided within the previous 7 days nor leading to an evaluation and management service or procedure within the next 24 hours or soonest available appointment, 5-10 minutes of medical discussion 
Key Points-Virtual Checkin
  • Must be patient initiated 
  • Can only be reported for established patients 
  • Can not be initiated originated from a related E/M service from previous 7 days 
  • Does not lead to an E/M service within the next 24 hours or soonest available appointment. 
  • CMS has agreed to this code and reimbursement and has deleted existing Medicare only code G2012. 

How Ventra Can Help

Ventra coders have received comprehensive training and education on the new CPT codes. We are committed to partnering with our providers to ensure they fully understand these new codes and how they apply to the services they perform.

Contact our Provider Education team to learn more.

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