Summary & Overview

CPT 98001: New Patient Telehealth E/M, Low MDM or ≥30 Minutes

CPT code 98001 designates a synchronous audio–video evaluation and management visit for a new patient when the encounter involves low medical decision making or when the provider spends 30 or more minutes of total time on the single date of service. As telehealth continues to be incorporated into ambulatory care, this code defines a specific new-patient E/M telehealth service tied to time and decision-making thresholds, supporting consistent billing and clinical documentation nationwide.

Key payers covered in this publication include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of what the code represents, how it is typically used in outpatient telehealth encounters, and the operational context for time-based and low-complexity new-patient visits.

The report outlines benchmarks and coverage posture where available, summarizes relevant policy and coding considerations for clinicians and billing staff, and clarifies typical sites of service and service type. If specific payer policies, modifiers, or diagnosis mappings are not provided in the source input, those items are noted as not available. This summary is written for a national audience to support consistent understanding of CPT code 98001 in telehealth E/M workflows.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare98001CPTtelehealthnew-patientevaluation-and-managementtime-based-codinglow-medical-decision-making

Billing Code Overview

CPT code 98001 describes a new patient evaluation and management (E/M) visit provided via synchronous audio–video telehealth. The visit is characterized by low medical decision making and/or 30 or more minutes of total provider time spent on a single date of service.

Service type: Telehealth — synchronous audio–video E/M for a new patient

Typical site of service: Ambulatory/Outpatient setting conducted remotely via video conferencing technology

Data not available in the input.

Clinical & Coding Specifications

Clinical Context

A 42-year-old new patient schedules an initial evaluation with a primary care physician via a secure synchronous audio–video telemedicine visit for progressive fatigue, intermittent palpitations, and uncontrolled hypertension. The provider conducts a comprehensive history, reviews prior outside records that the patient submits electronically, performs a focused virtual review of systems and medications, and observes the patient via video for signs of heart failure or thyrotoxicosis. The visit involves low medical decision making and the physician spends 30 or more minutes of total time on the encounter on a single date documenting history review, care coordination (including obtaining prior labs and medication lists), patient education, and establishing a plan of care. The encounter is billed as 98001 for a new patient synchronous audio–video evaluation with low medical decision making and ≥30 minutes total time. Typical workflow steps include: scheduling and consent for telehealth, pre-visit record collection, synchronous video encounter with history and limited virtual exam, ordering baseline labs and imaging as indicated, electronic prescription or medication reconciliation, and documentation of total encounter time and decision making sufficient to support 98001. Typical site of service is the patient’s home or other non-facility remote location where synchronous audio–video communication is used.

Coding Specifications

Modifier	Description	When to Use

Taxonomy Code	Specialty	Notes
207Q00000X	Family Medicine	Primary care physicians commonly perform new patient telehealth evaluations coded as `98001`.
208D00000X	General Practice	General practitioners provide comprehensive new patient assessments via telehealth.
208000000X	Internal Medicine	Internists evaluate new adult patients via synchronous video visits for medical management and initial workup.
363L00000X	Telemedicine	Providers with telemedicine-focused taxonomies frequently deliver services represented by `98001` and manage telehealth workflows.
207R00000X	Nurse Practitioner	Nurse practitioners conduct new patient telehealth evaluations and can bill under appropriate payer policies for `98001` when allowed.

ICD-10 Code	Description	Clinical Relevance
Data not available in the input.	Data not available in the input.	Data not available in the input.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99441`	Telephone evaluation and management service by a physician or other qualified health care professional, 5-10 minutes of medical discussion	May be used when the encounter is audio-only and shorter in duration; not appropriate when synchronous audio–video meeting meets `98001` criteria.
`99421`	Online digital evaluation and management service, for an established patient, cumulative time over 7 days	Related for asynchronous digital communications that may supplement a video visit but are distinct from the synchronous `98001` visit.
`99457`	Remote evaluation of recorded video and/or images submitted by an established patient, 20 minutes or more of clinical staff/physician time	Used for remote monitoring or asynchronous review that can follow an initial telemedicine `98001` visit for ongoing management.
`99203`	Office or other outpatient visit for the evaluation and management of a new patient, low complexity (typically 30 minutes)	In-person equivalent for a new patient evaluation with low medical decision making and comparable time; may be billed when the visit is conducted face-to-face instead of via telehealth.
`99091`	Collection and interpretation of physiologic data digitally stored and/or transmitted by the patient; requires 30 minutes of time	May be performed in the same episode of care for patients requiring remote monitoring in addition to the initial telehealth evaluation billed as `98001`.
`99406`	Smoking and tobacco cessation counseling visit, intermediate, greater than 3 minutes up to 10 minutes	Counseling services commonly provided during the new patient visit and may be billed separately per payer rules if criteria for distinct counseling are met.

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