Summary & Overview

CPT 98005: Established Patient Telehealth E/M Visit, Low Complexity

CPT code 98005 designates a synchronous audio–video evaluation and management visit for an established patient characterized by low medical decision making and/or at least 20 minutes of total provider time on a single date. This telemedicine-specific E/M code captures a common category of remote care that has grown nationally as virtual encounters expand across specialties. The code matters because it standardizes billing for time-based, low-complexity telehealth visits and affects clinician documentation, coding workflows, and payer reimbursement policies.

Key payers addressed in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of payer coverage patterns, common modifier usage, and where 98005 fits relative to other telehealth E/M services. The publication outlines benchmark expectations for encounter time and decision-making level, recent policy changes that influence telehealth coding and coverage, and practical billing considerations such as service line classification and typical site-of-service designation. Data not available in the input will be identified as such in the relevant sections.

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Billing Code Overview

CPT code 98005 describes an established patient evaluation and management visit delivered using synchronous audio–video technology. The service reflects a virtual visit in which the clinician conducts an evaluation with low medical decision making and/or documents 20 or more minutes of total time spent on the encounter on a single date.

Service type: Telemedicine / synchronous audio–video evaluation and management visit for an established patient
Typical site of service: Virtual/remote (telehealth) — the encounter is delivered via real-time audio and video communication rather than an in-person office or facility visit

Clinical & Coding Specifications

Clinical Context

A 58-year-old established patient with well-controlled type 2 diabetes and hypertension requests a scheduled follow-up via synchronous audio–video telehealth due to mobility limitations and transportation barriers. The visit is an evaluation and management encounter conducted by the patient’s primary care physician using a secure video platform. The clinician spends a total of 22 minutes on the single-date encounter, reviews recent home blood glucose logs, discusses current antihypertensive medication adherence, assesses mild ankle swelling reported by the patient, and documents low medical decision making: review of controlled chronic conditions, minor medication adjustment (dose titration), and anticipatory counseling. No in-person procedures are performed. The clinical workflow includes pre-visit chart review, patient check-in and verification of identity, focused history and systems review via video, review of home vitals and medication list, documentation of time spent and clinical decisions, and electronic prescription or message follow-up. Telehealth visit modality is synchronous audio–video consistent with code 98005 criteria.

Coding Specifications

Modifier	Description	When to Use
`25`	Significant, separately identifiable E/M service by the same physician on the same day	When a distinct E/M visit is provided same day as a procedure performed in-office (rare for pure telehealth encounters)

Taxonomy Code	Specialty	Notes
`207Q00000X`	Family Medicine	Primary care clinicians commonly deliver established-patient telehealth E/M visits
`208D00000X`	Internal Medicine	Internists provide chronic disease follow-up visits via telehealth
`207R00000X`	Emergency Medicine	Emergency physicians may use telehealth for follow-up or triage of established patients
`2084P0800X`	Nurse Practitioner	Nurse practitioners commonly perform telehealth established-patient evaluations
`363L00000X`	Physician Assistant	Physician assistants routinely conduct telehealth follow-ups under supervising physician

ICD-10 Code	Description	Clinical Relevance
`E11.9`	Type 2 diabetes mellitus without complications	Common chronic condition managed via telehealth established patient visits for medication adjustment and glucose review
`I10`	Essential (primary) hypertension	Frequently addressed during telehealth follow-up visits for blood pressure control and medication titration
`M25.57`	Pain in ankle and joints of foot	Example of a localized musculoskeletal complaint discussed and triaged via video
`R06.02`	Shortness of breath	Symptom that may be evaluated by telehealth to determine need for in-person assessment or escalation
`Z79.82`	Long term (current) use of oral hypoglycemic drugs	Common chronic therapy context reviewed during diabetes telehealth follow-up

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 audio-only follow-up is appropriate and brief instead of a synchronous audio–video visit
`99443`	Telephone E/M service, 11-20 minutes of medical discussion	Alternative for longer audio-only encounters when video is not available
`99421`	Online digital E/M service, for established patient, cumulative time over 7 days	Used for non–synchronous secure messaging or portal-based management that supplements the telehealth visit
`99091`	Collection and interpretation of physiologic data digitally stored and/or transmitted by patient and/or caregiver to clinician, 30 minutes	May accompany telehealth visits when remote patient monitoring data (e.g., glucose logs) is formally reviewed
`99024`	Postoperative follow-up visit global period not incremented	When a telehealth E/M is part of routine postoperative care and reported per payer guidance if routine follow-up is not separately payable
`99213`	Office or other outpatient visit for an established patient, typically 15 minutes, low MDM	In scenarios where the encounter shifts to in-person, `99213` represents the comparable in-person established patient E/M visit

Note: All CPT codes are presented to illustrate common clinical workflows associated with an established patient synchronous audio–video telehealth E/M visit 98005. When multiple codes are applicable, follow payer-specific billing guidance.

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