Summary & Overview

CPT 98010: New Patient Audio-Only Evaluation, Moderate Complexity

CPT code 98010 designates a new-patient evaluation and management visit delivered via synchronous audio-only telecommunication. The code applies when the encounter requires more than 10 minutes of medical discussion and involves moderate medical decision making, or when the clinician documents 45 or more minutes of total encounter time on a single date. As audio-only telehealth remains an access option for patients without video capability, this code clarifies billing for substantial telephonic clinical services that approximate in-person complexity.

Key payers in the national context include Aetna, Blue Cross Blue Shield plans, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what the code represents, payer coverage patterns, relevant billing considerations, and the clinical situations that typically generate use of this code. The publication covers benchmarks and reimbursement context where available, summarizes recent policy shifts affecting audio-only telehealth adoption, and outlines typical service lines and sites of service tied to this code.

This summary is intended for clinicians, billing professionals, and policy analysts seeking a national-level briefing on CPT code 98010, its clinical intent, and its role in telehealth service delivery.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare98010CPTtelehealthaudio-onlynew-patient-evaluationevaluation-and-managementtelemedicineclinical-time-based-billing

Billing Code Overview

CPT code 98010 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 moderate medical decision making, and/or the provider documents 45 or more minutes of total time spent on the encounter on a single date.

Service type: Telemedicine — synchronous audio-only evaluation and management
Typical site of service: Remote/virtual (patient location outside a clinician’s office), delivered via real-time audio-only communication

Clinical & Coding Specifications

Clinical Context

A 52-year-old patient with multiple chronic conditions (type 2 diabetes mellitus and hypertension) requests a new patient audio-only telehealth visit by phone because they lack reliable video capability. The provider performs a comprehensive new patient evaluation via synchronous audio-only technology lasting over 10 minutes of focused medical discussion and documents moderate medical decision making and/or at least 45 minutes of total provider time on the encounter date. The workflow includes patient identification and consent for audio-only telehealth, review of prior records and medication list, focused history of present illness, review of systems, virtual medication reconciliation, assessment of current control of chronic conditions, and development of a management plan which may include medication adjustments, laboratory orders, imaging referrals, and scheduling of follow-up (in-person or telehealth). Documentation captures time spent, medical decision complexity, informed consent for audio-only modality, and any care coordination activities performed during the encounter.

Coding Specifications

Modifier	Description	When to Use
`95`	Synchronous telemedicine service rendered via real-time interactive audio and video telecommunications system	Use when the telehealth visit is conducted with real-time audio-video (not applicable for audio-only); included for completeness when video is used instead of audio-only.

Taxonomy Code	Specialty	Notes
207Q00000X	Family Medicine	Primary care physicians frequently perform new patient telehealth evaluations for chronic disease management and acute complaints.
207R00000X	Internal Medicine	Internists perform comprehensive new patient evaluations for complex adults via telehealth.
261QP2000X	Physician Assistant	PAs commonly conduct telephonic new patient evaluations under physician supervision.
367A00000X	Nurse Practitioner	NPs perform new patient telehealth assessments and care planning.
208000000X	Emergency Medicine	Emergency physicians may conduct audio-only triage/new patient assessments for urgent complaints.

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

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 (note: code retired in recent CPT updates)	Alternative in-person new patient E/M code for brief visits; used when the encounter is in-person instead of audio-only.
`99204`	Office or other outpatient visit for the evaluation and management of a new patient, moderate complexity, typically 45 minutes	In-person counterpart for a comprehensive new patient visit with moderate MDM or 45 minutes total time; mirrors the service intensity documented for `98010`.
`99441`	Telephone evaluation and management service provided by a physician to an established patient, 5-10 minutes of medical discussion	Lower-intensity audio-only telephone visit codes for shorter encounters; used when total discussion time is less than required for `98010` or for established patients.
`99442`	Telephone E/M service, 11-20 minutes of medical discussion	Applies for audio-only encounters of intermediate duration for established patients; contrasts with new patient requirement of `98010`.
`99091`	Collection and interpretation of physiologic data digitally stored and/or transmitted by the patient and reviewed by the physician	May accompany telehealth management when remote monitoring data are reviewed as part of decision making.

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