CPT 98002 Telehealth Reimbursement & Policy

CPT code 98002 represents a telehealth new patient evaluation and management visit delivered via synchronous audio–video technology. It is defined by moderate medical decision making and/or a total provider time of 45 minutes or more on a single date. As virtual care continues to expand, this code matters nationally because it standardizes billing for higher-intensity telehealth encounters for patients who are new to a clinician, affecting care access, documentation requirements, and reimbursement workflows across payers.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the code’s clinical scope, typical sites of service, and the role of time and medical decision making in code selection. The publication outlines common modifiers associated with telehealth billing, summarizes payer coverage considerations, and highlights operational and documentation implications for providers. It also situates 98002 in the broader telehealth E/M landscape to aid coding accuracy and claims adjudication.

This national summary is intended for billing leaders, compliance officers, clinicians involved in telehealth, and policy analysts seeking a concise reference on the clinical and administrative contours of CPT code 98002.

Billing Code Overview

CPT code 98002 describes a new patient evaluation and management visit delivered using synchronous audio–video technology. The service reflects telehealth evaluation for a patient not previously seen by the provider and involves moderate medical decision making and/or 45 or more minutes of total provider time spent on the encounter on a single date.

Service type: Telehealth / Synchronous Audio–Video Evaluation & Management

Typical site of service: Remote/virtual setting (patient location varies), provider office or other outpatient virtual care setting

Data not available in the input.

Clinical Context

A typical patient presenting for 98002 is a new patient requiring a comprehensive synchronous audio–video evaluation conducted remotely. Example: a 58-year-old patient with poorly controlled type 2 diabetes and progressive shortness of breath requests a telemedicine intake because of mobility limitations and transportation barriers. The clinician obtains a focused history, reviews prior records, reviews current medications, performs visual inspection via video (skin, breathing effort), and coordinates remote vitals reported by the patient (home glucometer, pulse oximeter). The visit includes moderate medical decision making and requires at least 45 minutes of total provider time on the date of service for evaluation, documentation, coordination with specialists, and ordering of diagnostics (laboratory tests, chest radiograph arranged at a local facility).

Workflow steps:

Initial patient contact and consent for video visit.
Pre-visit record retrieval and review of prior notes and recent labs.
Synchronous audio–video encounter: comprehensive history, review of systems, visual exam components, assessment and moderate-complexity decision making.
Ordering tests and medications, electronic prescriptions, and care coordination (referrals, scheduling imaging).
Documentation of total time spent on the encounter on the same date to support 98002 billing.

Typical site of service: synchronous telemedicine (video) delivered to the patient in a non-facility or facility location (patient home, nursing facility) when the provider is remote.

Service type: New patient telehealth evaluation and management via synchronous audio–video technology, moderate complexity, 45+ minutes total provider time on the date of service.

Coding Specifications

Modifier	Description	When to Use
`95`	Synchronous telemedicine service rendered via real-time interactive audio and video telecommunications system	Append when the service was furnished via live audio–video telemedicine in accordance with payor policy

| GT | Via interactive audio and video telecommunications systems (payer-specific) | Use for telehealth when payer requires GT instead of 95

| G0 | Telehealth services provided for diagnosis, evaluation, or treatment of symptoms of COVID-19 | Use when the encounter meets 98002 criteria and is for suspected or confirmed COVID-19 per payor rules

| 25 | Significant, separately identifiable E/M service by the same physician on the same day as a procedure | Use when an additional in-person procedure is billed the same day and the telemedicine E/M is a distinct service

| 23 | Unusual anesthesia — typically for outpatient procedures | Use only if unusual circumstances require anesthesia and modifier is applicable to an associated billed procedure

| 22 | Increased procedural service beyond typical — for unusually complex work | Use only if documentation supports substantially greater work for an associated procedure

| 52 | Reduced services | Use when the full service described by the CPT is partially reduced or not completed

| 53 | Discontinued procedure | Use when the telehealth encounter led to a service that was started but discontinued

| 95 | (Duplicate entry intentionally omitted) | (Duplicate)

| 93 | Synchronous telemedicine service rendered via audio-only (new code category) | Use only when payer accepts audio-only and the code maps to allowed services; verify coverage for 98002

| 33 | Preventive service | Use when the encounter is a preventive telehealth service and payor requires this modifier

| GC | Service performed by a resident under the direction of a teaching physician | Use if the encounter was provided by a resident in a teaching setting with appropriate supervision

| GZ | Item/service expected to be denied as not reasonable or necessary | Use when the provider documents that the service is not reasonable/necessary and the payor requires the modifier

| QY | Certified registered nurse anesthetist service with medical direction | Use only when relevant to associated anesthesia services

Taxonomy Code	Specialty	Notes
`163W00000X`	Internal Medicine	Common specialty performing new patient telehealth evaluations for chronic disease management and acute complaints

| 207Q00000X | Family Medicine | Frequently provides comprehensive new patient telehealth visits for adults and children

| 207R00000X | Psychiatry & Neurology (Psychiatry) | Performs initial telehealth psychiatric evaluations that can meet moderate decision making and ≥45 minutes total time

| 208000000X | Hospitalist | Performs telemedicine admissions or remote intake evaluations for patients in other facilities

| 363L00000X | Nurse Practitioner | Advanced practice providers frequently deliver telehealth new patient E/M services and bill under their taxonomy or supervising physician

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`E11.9`	Type 2 diabetes mellitus without complications	Common chronic condition prompting comprehensive new patient telehealth evaluation for management and medication adjustments

| J18.9 | Pneumonia, unspecified organism | Acute respiratory complaints evaluated via telehealth when in-person exam is limited; may prompt ordering of imaging and antibiotics

| I10 | Essential (primary) hypertension | Common comorbidity assessed and addressed during a comprehensive remote new patient evaluation

| R06.02 | Shortness of breath | Symptom frequently evaluated by telemedicine; guides escalation, testing, or referral

| F41.9 | Anxiety disorder, unspecified | Behavioral health presentations that often begin with telehealth new patient evaluations, especially when longer time is required

| M54.5 | Low back pain | Musculoskeletal complaint frequently managed initially via telehealth with evaluation, triage, and imaging orders if needed

| R51 | Headache | Common neurologic complaint evaluated by telehealth for history, red-flag screening, and management planning

| Z71.89 | Other specified counseling for health behavior | Counseling and care coordination often performed during a comprehensive telehealth new patient visit

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99205`	Office or other outpatient visit for the evaluation and management of a new patient, moderate to high complexity, typically 60–74 minutes	In-person counterpart for a comprehensive new patient evaluation with high time; used when patient is seen face-to-face rather than via telemedicine

| 99204 | Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity, typically 45–59 minutes | In-person E/M code similar in content and time to 98002 when the encounter occurs face-to-face

| 99441 | Telephone evaluation and management service by a physician or other qualified health care professional; 5–10 minutes of medical discussion | Related remote communication code for problem-focused audio-only visits that are shorter than 98002

| 99421 | Online digital evaluation and management service, for an established patient, cumulative time over 7 days | Related asynchronous digital E/M option; not a direct substitute but used in remote care workflows

| 99091 | Collection and interpretation of physiologic data by a physician or other qualified health care professional | Often used adjunctively when remote monitoring data (glucose, pulse oximetry) are reviewed as part of the telehealth evaluation

| 99457 | Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified healthcare professional time in a calendar month | May be used in the continuum of care when ongoing remote monitoring is initiated following the 98002 initial telehealth evaluation

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Summary & Overview

CPT 98002: New Patient Telehealth E/M Visit, Moderate Complexity