Policy / Article-002
Telemedicine E/M Services Educational Guide
- Effective Date: 01/01/2026
- Reviewed/Revised Date: 01/01/2026
- Next Review Date: 12/31/2026
- Origination Date: 01/01/2026
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Originated Department:
Correct Coding Integrity
Audience
This resource sheet applies to all professionals involved in telemedicine E/M services.
- AMA CPT® Evaluation and Management Guidelines
- CMS E/M Documentation Requirements
Clinical Providers
✓ Physicians
✓ Nurse Practitioners (NPs)
✓ Physician Assistants (PAs)
✓ Telehealth clinical specialists
Coding & Billing Professionals
✓ Medical Coders
✓ Clinical Documentation Improvement (CDI) specialists
✓ Revenue Cycle staff
✓ Compliance and audit personnel
Overview
Telemedicine visits use standard E/M CPT codes for office/outpatient or other settings. The key difference is place of service (POS), modifiers, and documentation.
➔ Audio-only visits may use 99441–99443 (physician) or 98966–98968 (nonphysician), depending on payer.
➔ Always confirm payer telehealth policies for covered services.
➔ Leveling Telemedicine Visits: MDM vs Time Telehealth visits can be leveled using either MDM or total time.
1. Ensure telehealth consent is captured.
2. Validate MDM or time documentation supports code level.
3. Confirm diagnoses, labs, and imaging orders are documented.
4. Verify modifier 95 and POS align with payer requirements.
5. Audit for appropriateness of audio-only vs video coding.
Common Audit Triggers
- Missing patient consent statement
- No documentation of provider or patient location
- Total time not documented when using time-based coding
- Overstated physical exam findings
- Missing telehealth-specific modifiers or POS
- Lack of clinical rationale for MDM complexity
Documentation must reflect the telemedicine nature of the encounter:
✓ Patient consent – Document that the patient agreed to a telemedicine visit.
✓ Type of technology – Indicate whether the visit was video, audio-only, or asynchronous.
✓ Location of provider and patient – Document provider’s location and patient’s originating site.
✓ History & Exam – Virtual exam is limited; document observations, questions, and any remote assessments.
✓ MDM or time – Clearly document MDM elements or total time.
✓ Assessment & Plan – Include diagnosis, treatment plan, labs, imaging, prescriptions, and follow-up.
✓ Coding & Billing – Include CPT code, modifier 95, and POS 02/10.
✓ Telehealth-specific notes – Example: “Visit conducted via secure video telemedicine. Patient consented. Exam limited due to virtual modality.”
- Number & complexity of problems addressed
- Amount and/or complexity of data reviewed
- Risk of morbidity or mortality
Include all provider time on the telemedicine visit:
a.) Pre-visit prep (review labs, imaging, records)
b.) Face-to-face audio/video time
c.) Documentation, orders, patient instructions
Telemedicine E/M Coding
Pro Tip
Telemedicine visits use standard E/M CPT codes for office/outpatient or other settings. The key difference is place of service (POS), modifiers, and documentation.
Visit Type
CPT Codes
Notes
New patient
99202 – 99205
Time or MDM based, same as in-person visits
Established patient
99212 – 99215
Time or MDM based
Brief / Follow-Up
99211
Minimal MDM, may be used for telehealth check-ins
Preventive Services
99381 – 99397
Telehealth preventive visits may have restrictions per payer
2026 Telemedicine Time-Based E/M Codes
Pro Tip
Documentation must reflect the telemedicine nature of the encounter. See full checklist ➔
Modifier
Total Time (minutes)
99202
15–29
99203
30–44
99204
45–59
99205
60–74
99212
10–19
99213
20–29
99214
30–39
99215
40–54
Telemedicine Coding Modifiers & Billing Tips
Pro Tip
1. Always check payer-specific rules for audio-only visits.
2. Document any limitations due to telehealth vs in-person care.
3. Include time spent if coding based on time.
Modifier 95 – Synchronous telemedicine service via real-time interactive audio and video – concise and specific
Modifier GT (Medicare) – Telehealth via interactive audio/video, optional per payer
Place of Service 02 – Telehealth provided other than patient’s home
Place of Service 10 – Patient’s home (Medicare allowed for 2026)
Modifier
Use
Notes
95
Telehealth service via realtime audio/video
Required by most commercial payers
GT
Telehealth, interactive audio/video
Medicare specific
52
Reduced services
If telehealth visit limits exam elements
95 + POS 02
Standard telemedicine
Use if patient not at home
95 + POS 02
Telehealth at patient’s home
Medicare recognizes this for 2026
Revision History
01/01/2026
Correct Coding Integrity
03/23/2026
Revised by Mountain Health CO-OP Policy Committee
Disclaimer
This document is for informational purposes only. It should not replace clinical judgment or provide medical advice. Coverage, benefits, and eligibility are determined by the member’s benefit plan. CPT codes and procedures included are for informational purposes only and do not guarantee reimbursement. © CPT Only – American Medical Association