Wiki 2025 Telemedicine Codes - Less than 10 mins

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KoBee

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Noticed the time component on the new 2025 Telemedicine codes and noticed there isn't anything for LESS than 10mins anymore.

Anything less than 10mins is not billable for Audio or Audio & Video? I did notice 98016 but that is for established brief virtual check in only.

What are other practices doing or telling their provides regarding any telemedicine of less than 10mins?


HELP!!
 
I came here looking for the same answer. The other codes also say "10 minutes of medical discussion" so we would have an overlap on code description for exactly 10 minutes but in most cases there would be that discussion + everything else that can account for total time. I read somewhere that verbiage was added so as not to account for time for A/V hook up or technical difficulties.

The 98000-98015 Excludes note does say "Audio-only telemedicine service, 5 to 10 minutes medical discussion ([98016])."

But 98016 is only for established patients, what about new patients?

Previously, if time threshold wasn't met, we would need to use MDM, maybe it's as easy as that.
 
In 2025, the telemedicine audio-video codes are just like the office visit codes, report them based either on total time or MDM. For example, the established patient visit that would require 10 minutes total time may be more frequently selected based on MDM. These codes have no requirement for a specific number of minutes spent in medical discussion.
The audio-only codes do have a requirement for more than 10 minute of medical discussion (distinctly required time for medical discussion) in addition to the options of code selection based on total time (ie, time of medical discussion plus other physician or QHP time on the date of service or on MDM. The audio-only telemedicine service to a new patient that does not include more than 10 minutes of medical discussion would not be reported. If the patient is established, and all other requirements for 98016 are met (eg, service is patient-initiated and for purposes of determining if a more extensive visit is indicated), an audio-only service of at least 5 minutes and not more than 10 minutes would be reported with 98016.

Be sure to review payer policies, especially for payers that generally adopt Medicare policies, as they may require use of codes other than the telemedicine codes (eg, office visit codes with modifier 93 or 95) despite CPT instructions.

I hope that helps.
Cindy
 
Cynthia Hughes said:
In 2025, the telemedicine audio-video codes are just like the office visit codes, report them based either on total time or MDM. For example, the established patient visit that would require 10 minutes total time may be more frequently selected based on MDM. These codes have no requirement for a specific number of minutes spent in medical discussion.
The audio-only codes do have a requirement for more than 10 minute of medical discussion (distinctly required time for medical discussion) in addition to the options of code selection based on total time (ie, time of medical discussion plus other physician or QHP time on the date of service or on MDM. The audio-only telemedicine service to a new patient that does not include more than 10 minutes of medical discussion would not be reported. If the patient is established, and all other requirements for 98016 are met (eg, service is patient-initiated and for purposes of determining if a more extensive visit is indicated), an audio-only service of at least 5 minutes and not more than 10 minutes would be reported with 98016.

Be sure to review payer policies, especially for payers that generally adopt Medicare policies, as they may require use of codes other than the telemedicine codes (eg, office visit codes with modifier 93 or 95) despite CPT instructions.

I hope that helps.
Cindy
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Thank you for the confirmation. Is your organization requiring an attestation to specifically state "XX minutes of medical discussion was performed?"
 
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