Clinical Context
A 42-year-old new patient requests an initial evaluation for recurrent migraine headaches and photosensitivity. The patient completes intake forms and initiates a scheduled synchronous audio–video visit using the health system’s telemedicine platform. The provider documents a focused history of present illness, reviews prior imaging and medication trials, performs a limited virtual neurologic assessment, and discusses treatment options. The encounter involves straightforward medical decision making and the clinician spends at least 15 minutes of total time on the single date of service. The visit is billed with 98000 to reflect a new patient evaluation performed via synchronous audio–video technology. Typical workflow steps: rooming via telehealth intake, verification of patient identity and location, review of medications and allergies, focused history and review of systems, virtual exam maneuvers as feasible, shared decision-making discussion, documentation of time spent, and scheduling of follow-up or in-person evaluation if indicated. Typical site of service: outpatient telemedicine visit conducted from the provider’s office or designated telehealth location to the patient’s home or other permitted remote location. Service type: synchronous audio–video new patient evaluation and management visit with straightforward MDM and total time ≥15 minutes on the date of service.
Coding Specifications
| Modifier | Description | When to Use |
|---|
00 | No modifier | Standard reporting when no modifier applies |
| 22 | Increased procedural services | Use when work required is substantially greater than typical for 98000 due to complexity or documentation supporting increased work |
| 23 | Unusual anesthesia | Rarely applicable; use if telehealth visit required unexpected general anesthesia (very uncommon for telemedicine) |
| 25 | Significant, separately identifiable E/M service on the same day | Use when 98000 is provided in addition to another procedure on the same date and the telehealth E/M is distinct and significant |
| 52 | Reduced services | Use when the telehealth encounter is partially reduced or curtailed and should be reported at reduced scope |
| 53 | Discontinued procedure | Use if the telehealth visit is started but discontinued due to patient or clinical circumstance before completion |
| 95 | Synchronous telemedicine service provided via real-time interactive audio and video | Use to indicate the service was delivered via an interactive audio–video telecommunication system when required by payer |
| GT | Via interactive audio and video telecommunications systems | Use when payer requires the GT modifier to identify interactive telehealth services |
| QY | Telehealth originating site facility fee not paid by practitioner | Use for billing contexts requiring certification that service is a telehealth originating site-permitted service when applicable |
| 93 | Synchronous telemedicine service rendered via telephone only | Use only when audio–video is not available and payer recognizes 93 for telephone-only synchronous services (verify payer policy) |
| 95 | Synchronous telemedicine service provided via real-time interactive audio and video | (Duplicate entry avoided in payer systems; ensure single use per payer rules) |
| 25 | Significant, separately identifiable E/M service on the same day | (Ensure documentation supports separate E/M) |
| Taxonomy Code | Specialty | Notes |
|---|
2084P0800X | Neurology | Neurologists frequently perform new patient telemedicine evaluations for headaches and neurologic complaints |
| 207Q00000X | Family Medicine | Primary care clinicians commonly perform new patient telehealth E/M visits for a broad range of conditions |
| 207L00000X | Internal Medicine | Internists provide comprehensive new patient telemedicine evaluations for adult patients |
| 363LP0800X | Nurse Practitioner | NPs perform telemedicine new patient visits in outpatient settings |
| 367A00000X | Physician Assistant | PAs provide telehealth new patient evaluations under supervising agreements
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|
G43.709 | Migraine, unspecified, intractable, without status migrainosus | Common reason for a new neurology telemedicine evaluation for headache management |
| R51 | Headache | Frequent presenting symptom prompting a new patient telemedicine E/M visit |
| F41.9 | Anxiety disorder, unspecified | Often comorbid and relevant to treatment planning during new patient telemedicine evaluations for headaches or related complaints |
| M54.2 | Cervicalgia | Neck pain can be associated with head pain and is commonly assessed during remote musculoskeletal or neurologic evaluations |
| R53.1 | Weakness | Generalized or focal weakness may prompt a new patient telemedicine evaluation and influence decision making |
| G44.209 | Tension-type headache, unspecified, not intractable | Another common diagnosis evaluated via telemedicine for initial management and follow-up |
| I10 | Essential (primary) hypertension | Chronic comorbidity often reviewed during new patient telemedicine evaluations to assess medication interactions and cardiovascular risk
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|
99201 | Office or other outpatient visit for the evaluation and management of a new patient, typically 10 minutes | Alternative in-person new patient E/M code for a brief visit; used when patient is seen face-to-face rather than via telehealth |
| 99202 | Office or other outpatient visit for the evaluation and management of a new patient, typically 20 minutes | In-person new patient E/M code for straightforward MDM and time comparable to 98000 when care is delivered face-to-face |
| 99441 | Telephone evaluation by a physician or other qualified health care professional, 5-10 minutes of medical discussion | Used when audio-only telephonic management is performed instead of synchronous audio–video and payer permits billing |
| 99091 | Collection and interpretation of physiologic data digitally stored and/or transmitted by the patient and/or caregiver to the physician | May be performed in follow-up to a telemedicine new patient visit when remote monitoring data are reviewed and interpreted |
| 99457 | Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified healthcare professional time | May follow a telemedicine new patient evaluation when RPM services are initiated and managed as part of the care plan