CPT 98008 Reimbursement & Policy Benchmarks | OpenPayer

Summary & Overview

CPT 98008: New Patient Audio-Only Evaluation and Management

CPT code 98008 identifies a new patient evaluation and management visit conducted via synchronous audio-only telecommunication. It covers encounters with more than 10 minutes of medical discussion and/or those in which the clinician records 15 or more minutes of total time on the date of service, with straightforward medical decision making. Nationally, this code formalizes reimbursement for audio-only telehealth for new patients, clarifying billing options for providers and payers where video access may be limited.

Key payers included in this overview are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise summary of the clinical context for audio-only new patient E/M encounters, payer coverage considerations, and how the code aligns with telehealth policy trends. The publication highlights benchmarks and policy updates relevant to billing and claims adjudication, operational implications for clinical workflows, and points of attention for documentation and time-based reporting. Data not available in the input is noted where specific payer policies, modifiers usage, and associated taxonomies would normally be detailed.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare98008CPTaudio-only telehealthnew patient E/Mtime-based billingtelemedicine policyremote careevaluation and managementstraightforward decision making

Billing Code Overview

CPT code 98008 describes a new patient evaluation and management visit delivered using synchronous audio-only technology. The service requires more than 10 minutes of medical discussion and 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: Audio-only telehealth evaluation and management (new patient)

Typical site of service: Remote/virtual (audio-only) — patient location and provider location are separate at the time of the encounter

Clinical & Coding Specifications

Clinical Context

A 48-year-old patient with a new onset of intermittent chest pain and palpitations calls the primary care clinic requesting an evaluation. The clinic schedules a synchronous audio-only visit because the patient lacks video-capable technology and cannot travel due to childcare obligations. The provider conducts a focused new-patient evaluation by phone, documents a medically relevant history of present illness, reviews past medical history and medications, performs a limited risk assessment for acute coronary syndrome, and engages in more than 10 minutes of medical discussion. The visit involves straightforward medical decision making (e.g., assessment of risk, ordering an ECG and labs, providing return precautions, and arranging urgent in-person testing). The provider documents total encounter time of 15 minutes or more on the same date and bills 98008 for a new patient synchronous audio-only E/M visit.

Typical clinical workflow:

Patient calls or is triaged by nursing and is identified as needing a provider audio-only evaluation.
The provider completes identity verification, documents consent for telephonic encounter, collects focused history, reviews medications/allergies, and assesses acute symptoms.
The provider performs clinical decision making: orders diagnostic testing (ECG, troponin), provides triage instructions, and schedules an in-person follow-up or urgent evaluation as indicated.
The provider documents: reason for visit, history, assessment, plan, time spent on the encounter (total time ≥15 minutes), and the use of synchronous audio-only technology.
Billing staff submits claim using 98008 with any applicable modifier(s) per payer and policy.

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

97810-ACUPUNCTURE-PROCEDURES-1-OR-MORE-NEEDLES-WITHOUT-ELECTRICAL

CPT 97810: Acupuncture, Initial 15 Minutes Without Electrical Stimulation

CPT-98016-VIRTUAL-BRIEF-EVALUATION-ESTABLISHED-PATIENT

CPT 98016: Brief Virtual Evaluation for Established Patients

CPT-97811-ACUPUNCTURE-ADDITIONAL-15-MINUTE-CONTINUATION

CPT 97811: Acupuncture, Manual Needling — Additional 15 Minutes

97814-ACUPUNCTURE-1-OR-MORE-NEEDLES-WITH-ELECTRICAL-STIMULATION

CPT 97814: Acupuncture with Electrical Stimulation, 15 Minutes

CPT-98003-TELEMEDICINE-NEW-PATIENT-EVALUATION-HIGH-COMPLEXITY-60MIN

CPT 98003: Telehealth New-Patient Evaluation, High Complexity

CPT-97813-ELECTROACUPUNCTURE-INITIAL-15-MINUTE-TREATMENT

CPT 97813: Electroacupuncture, Initial 15-Minute Treatment

CPT-98002-NEW-PATIENT-TELEHEALTH-EVALUATION-MODERATE-COMPLEXITY

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

Coding Specifications

Modifier	Description	When to Use
`95`	Synchronous telemedicine service rendered via real-time interactive audio and video telecommunications system	Use when the encounter uses audio–video telemedicine; not appropriate for audio-only `98008` but included when a visit is converted to audio-video.
`93`	Synchronous audio-only interaction	Use to indicate the service was provided via audio-only synchronous technology; commonly paired with `98008` per payer rules.
`25`	Significant, separately identifiable E/M service by the same physician on the same day of a procedure	Use when an in-person procedure or service is performed the same day and the audio-only E/M is a distinct visit requiring separate billing.
`95`	Note: Some payers prefer `GT` or `QY` instead of `95` depending on policy	Use payer-specific telehealth modifier per payer requirements.
`GT`	Via interactive audio and video telecommunication systems	Use when the visit is synchronous audio–video and payer requires `GT`; not for audio-only `98008`.
`QY`	Telehealth originating site direct contract with distant site telehealth provider	Use when billing requires indicating a Federal telehealth arrangement per payer rules.
`QX`	Telehealth services furnished using asynchronous telecommunications system; modifier QX often paired with QY/QZ in contracted arrangements	Use per payer contractual requirements for telehealth claims workflows.
`52`	Reduced services	Use when the provider documents that the service was partially reduced or not fully performed.
`22`	Increased procedural services	Use rarely for significantly greater work than typical, documented and justified; not common for standard `98008` audio visits.
`23`	Unusual anesthesia	Generally not applicable to `98008`; include when anesthesia is unexpectedly required during related in-person procedures on same day.
`59`	Distinct procedural service	Note: `59` is not in the provided list; do not add beyond provided list.
`95`	Duplicate entry avoided — see payer selection note above.

Provider taxonomies:

Taxonomy Code	Specialty	Notes
207Q00000X	Family Medicine	Family physicians commonly perform new patient telephonic evaluations.
207R00000X	Internal Medicine	Internists provide audio-only new patient E/M visits for acute complaints and care coordination.
207V00000X	Emergency Medicine	Emergency physicians may conduct triage or follow-up audio-only evaluations before directing to ED care.
208D00000X	General Practice	General practitioners perform telephonic new patient assessments in primary care settings.
363A00000X	Telephone Triage/Advice	Nurses and nurse practitioners using this taxonomy coordinate telephonic triage; advanced practice providers also bill for `98008` when allowed.

Notes: Select telehealth or payer-specific modifiers (93, 95, GT, QY, QX) according to payer policy. Use time and medical decision making documentation to support 98008 billing.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`R07.9`	Chest pain, unspecified	Common presenting symptom prompting an audio-only new patient evaluation for triage and testing orders.
`R00.2`	Palpitations	Frequent complaint evaluated via phone to assess severity, associated symptoms, and need for urgent testing.
`R51`	Headache	May present to primary care or urgent care via audio-only visit; requires assessment of red flags to determine need for in-person care.
`I10`	Essential (primary) hypertension	Chronic condition often reviewed during a new patient telephonic visit and may influence decision making.
`J02.9`	Acute pharyngitis, unspecified	Common acute complaint suitable for audio-only evaluation for symptom management and testing decisions.
`M54.5`	Low back pain	Frequently triaged by telephone to assess severity, red flags, and need for imaging or in-person evaluation.
`Z00.00`	Encounter for general adult medical examination without abnormal findings	May be used when a new patient audio-only visit includes preventive review or baseline assessment without acute findings.
`F41.9`	Anxiety disorder, unspecified	Behavioral health or somatic presentations evaluated by phone; influences counseling and follow-up planning.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99441`	Telephone evaluation and management service by a physician or other qualified healthcare professional, 5-10 minutes of medical discussion	May be used for shorter audio-only telephone E/M visits when total medical discussion is less than 10 minutes; alternative for audio-only services shorter than `98008` criteria.
`99442`	Telephone evaluation and management service by a physician or other qualified healthcare professional, 11-20 minutes of medical discussion	Used for audio-only telephone E/M visits with 11–20 minutes of medical discussion; overlaps with `98008` when payer allows telephone codes instead of telehealth-specific codes.
`99443`	Telephone evaluation and management service by a physician or other qualified healthcare professional, 21-30 minutes of medical discussion	Used when telephone medical discussion exceeds 20 minutes; may follow or replace `98008` depending on payer rules and documentation of time.
`99203`	Office or other outpatient visit for the evaluation and management of a new patient, typically 30 minutes	May be used for an in-person new patient E/M when the audio-only encounter leads to an in-person follow-up or conversion to face-to-face care; documents more extensive visit content.
`93000`	Electrocardiogram, routine ECG with at least 12 leads; tracing, interpretation and report	Common diagnostic test ordered after `98008` audio-only triage for chest pain; performed in-person following telephonic evaluation.
`36415`	Collection of venous blood by venipuncture	Common ancillary service ordered after an audio-only triage visit when labs (e.g., troponin) are indicated.

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