What’s New in Telemedicine for 2025? 

The American Medical Association (AMA) added a Telemedicine Services category to the Evaluation and Management section of CPT.  Codes are divided by technology used and patient type (i.e., new vs. established). These codes are for synchronous, real-time interactive encounters between the provider and the patient. Codes are leveled by medical decision making or time, same as the office visit codes. 

Billing for telemedicine visits is already complex with multiple places of services (POS) and modifiers (i.e., 93, 95, GT).  Each payer has required different combinations of these coding elements. Unfortunately, adding specific CPT codes to the mix will not simplify this. The Centers for Medicare & Medicaid Services (CMS) determined these new codes would not be covered based on the current language in the Social Security Act.   

The challenge in 2025 is to learn which payers want office visit codes (i.e., 99202-99215) and which require the new telemedicine codes.  

State laws also need to be considered. Many states have payment parity laws that require services to be paid the same as in-office codes.  While CMS is not covering these codes, they did price them. Based on that information, payment could be lower for telemedicine services in 2025. 

Practices will need to analyze payments to make sure they align with your contract and State laws. 

Current telephone call codes 99441-99443 are replaced by the audio-only codes: 98008-98015. A minimum of 10 minutes must be spent with the patient to bill a telephone call. Time must be documented in the medical record. 

Though CMS does not cover these codes, the payment information published has reimbursement for telephone only services ranging from 47.23 to 130.68. 

One code in this new category is covered by CMS: 98016 (Brief communication technology-based service (eg, 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). CPT code 98016 replaces the virtual check in code G2012. 

The virtual check-in is for established patients only and must be initiated by the patient. It’s a single 5-10 minute medical discussion that is not related to an E/M service in the prior seven (7) days or leading to a E/M service in the next 24 hours. The non-facility payment is $15.85. 

While telemedicine continues to be complicated from a billing standpoint, it’s a positive sign to see services expanding.  Telemedicine is here to stay.