Summary & Overview

CPT 98000: New Patient Telemedicine E/M Visit, Straightforward or ≥15 Minutes

CPT code 98000 represents a new-patient evaluation and management (E/M) visit delivered via synchronous audio–video telemedicine, with straightforward medical decision making or at least 15 minutes of provider time on a single date. As telehealth utilization remains a national health services priority, this code captures a common modality for initiating care remotely and standardizes reporting for brief, lower-complexity virtual new-patient encounters. Key national payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

Readers will find a concise explanation of what the code covers, the clinical and operational context for telemedicine new-patient E/M visits, and how major payers approach coverage and billing for such services. The publication outlines typical sites of service, common modifiers associated with telehealth billing (summary only), and where to find relevant policy guidance. It also highlights national benchmarking and policy trends affecting telemedicine billing and documentation for short new-patient visits. Data not available in the input is noted where specific payer policy details, taxonomies, ICD-10 mappings, and related codes would otherwise be required.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare98000CPTtelemedicinenew-patientevaluation-and-managementsynchronous-audio-videovirtual-caretelehealth-policy

Billing Code Overview

CPT code 98000 describes a new patient evaluation and management visit conducted using synchronous audio–video technology. The visit involves straightforward medical decision making and/or the provider spends 15 or more minutes of total time on the encounter on a single date.

Service type: Telemedicine, synchronous audio–video evaluation and management (new patient)

Typical site of service: Remote/virtual (patient at home or other non-facility location); provider office or other outpatient setting delivering care via live audiovisual connection

Clinical & Coding Specifications

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

Taxonomy Code	Specialty	Notes
`2084P0800X`	Neurology	Neurologists frequently perform new patient telemedicine evaluations for headaches and neurologic complaints

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

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

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