Summary & Overview

CPT 98009: Audio-Only New Patient Evaluation and Management

CPT code 98009 captures a new patient evaluation and management visit delivered via synchronous audio‑only technology when the encounter includes more than 10 minutes of medical discussion, involves low medical decision making, or the clinician documents 30 or more minutes of total time on a single date. This code matters nationally as telehealth expands access to care for patients without video capability and as payers and regulators refine coverage and payment policies for audio‑only services.

Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication summarizes how 98009 is defined, common billing scenarios, and the operational implications for outpatient and remote care delivery. Readers will find concise benchmarks and coding guidance context, recent policy developments relevant to audio‑only telemedicine, and clinical contexts where an audio‑only new patient evaluation may be appropriate. Where payer‑specific policies are not provided in the input, the document notes data unavailability.

The report is intended for billing managers, compliance officers, clinicians, and policy analysts who need a national overview of 98009, its clinical scope, and the payer landscape affecting reimbursement and telehealth program design.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare98009CPTtelehealthaudio-onlynew patientevaluation and managementremote caretelemedicine policy

Billing Code Overview

CPT code 98009 describes a new patient evaluation and management visit conducted using synchronous audio‑only technology. The service requires more than 10 minutes of medical discussion and involves low medical decision making, or the provider spends 30 or more minutes of total time on the encounter on a single date.

Service type: Audio‑only telemedicine new patient evaluation and management
Typical site of service: Remote/telehealth setting delivered via synchronous audio‑only communication (patient located offsite from the provider)

Clinical & Coding Specifications

Clinical Context

A patient in a primary care or behavioral health setting requests a new patient evaluation using audio-only telehealth. The patient is an adult with limited access to video technology or in a rural area where phone-based care is the only feasible synchronous option. The clinician (for example, a family medicine physician, psychiatric nurse practitioner, or clinical psychologist using appropriate billing taxonomy) schedules a dedicated phone visit. During the encounter the clinician conducts a comprehensive history, reviews past medical records sent by the patient, performs a focused review of systems by interview, and establishes a problem list. The visit involves more than 10 minutes of medical discussion and the clinician documents low medical decision making and/or documents total encounter time of 30 minutes or more on the same date. The workflow includes patient identity verification, consent for audio-only care, focused assessment and history, formulation of an assessment and plan, and arrangement of follow-up or referrals. Clinician documents modality as synchronous audio-only and appends the appropriate modifier for telehealth billing if required by payer.

Coding Specifications

Modifier	Description	When to Use
`95`	Synchronous telemedicine service rendered via real-time interactive audio and video	Use when payer accepts telehealth and service is audio–video (not typically for `98009`; included if visit changes modality to video and payer requires modifier)

Taxonomy Code	Specialty	Notes
`207Q00000X`	Family Medicine	Common primary care providers performing new patient audio-only evaluations
`207R00000X`	Internal Medicine	Hospital- or clinic-based internists conducting telephonic new patient assessments
`2084P0800X`	Nurse Practitioner	Frequently provides audio-only new patient evaluations under appropriate state scope
`2084N0400X`	Clinical Nurse Specialist	Provides telehealth assessments, including audio-only patient evaluations
`2084P0200X`	Physician Assistant	Performs new patient evaluations via telehealth under supervising physician

ICD-10 Code	Description	Clinical Relevance
`Z00.00`	Encounter for general adult medical examination without abnormal findings	Common reason for an initial new patient evaluation via audio-only when screening history is primary
`Z01.419`	Encounter for routine gynecological examination (general) without abnormal findings	May be used if the audio-only visit is for intake/history and referral for routine gynecologic care
`F41.9`	Anxiety disorder, unspecified	Frequently evaluated in new patient behavioral health assessments conducted via audio-only
`F32.9`	Major depressive disorder, single episode, unspecified	Common presenting problem for new psychiatric or primary care audio-only evaluation
`R07.9`	Chest pain, unspecified	Patients may present by phone with symptoms requiring new patient triage and evaluation via audio-only

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	Comparable in intent to a brief new patient E/M; `98009` is the audio-only telehealth counterpart when duration and MDM/time criteria match
`99202`	Office or other outpatient visit for the evaluation and management of a new patient, typically 20 minutes	Used when a new patient E/M via traditional office visit meets time or MDM; may be billed instead of `98009` when in-person care occurs
`99441`	Telephone evaluation and management service provided by a physician or other qualified health care professional to an established patient, 5-10 minutes of medical discussion	Shorter telephone E/M for established patients; `98009` is specific for new patients and requires >10 minutes
`99442`	Telephone evaluation and management service, 11-20 minutes	Telephone service for established patients with longer discussion; clinically similar duration considerations to `98009` but for established patients
`99443`	Telephone evaluation and management service, 21-30 minutes	Telephone E/M for established patients with longer time; helps define time-based billing parallels with `98009`

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