Clinical Context
A 56-year-old established primary care patient with type 2 diabetes and well-controlled hypertension calls the clinic reporting increased episodes of lightheadedness and new intermittent dizziness over the past 48 hours. The practice uses a synchronous audio-only telehealth workflow for patients without smartphone video access. The medical assistant verifies the patient's identity, documents consent for an audio-only visit, confirms location and emergency contacts, and records current medications and recent home blood pressure and glucose readings. The clinician connects via a secure audio-only platform and conducts a focused history and medication review lasting 12 minutes of medical discussion. The clinician performs clinical decision making of straightforward complexity: adjusts antihypertensive dosing, advises home monitoring, and arranges an in-person follow-up and laboratory testing. The encounter is billed with 98012 for an established patient synchronous audio-only evaluation and management visit requiring more than 10 minutes of medical discussion. Typical site of service is the patient’s home via telecommunication, using audio-only synchronous technology. Common payors for such services include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.
Coding Specifications
| Modifier | Description | When to Use |
|---|
25 | Significant, separately identifiable E/M service by the same physician on the same day of procedure or other service | Use when an unrelated or separately identifiable E/M service is provided during the same date as another procedure or service. |
| 52 | Reduced services | Use when the service provided is partially reduced or eliminated at the physician’s discretion.
| 53 | Discontinued procedure | Use when the service was started but discontinued due to extenuating circumstances.
| 95 | Synchronous telemedicine service rendered via real-time interactive audio and video | Use when the telehealth visit included audio and video (note: not appropriate for audio-only 98012).
| 93 | Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only communication system | Use specifically to denote audio-only telemedicine encounters in payor systems that recognize it.
| 22 | Increased procedural services | Use when work required to provide the service is substantially greater than typically required.
| 23 | Unusual anesthesia | Not commonly applicable to 98012; included for completeness when anesthesia is unexpectedly required.
| 95 | (duplicate removed) | (See above) |
| QY | Telehealth originating site facility service | Use by the originating site facility when applicable per payer policy.
| GT | Via interactive audio and video telecommunication systems | Use when the telehealth encounter includes interactive audio-video (not appropriate for audio-only 98012).
| 93 | (duplicate removed) | (See above) |
| Taxonomy Code | Specialty | Notes |
|---|
207Q00000X | Family Medicine | Common providers for established patient telephonic E/M visits. |
| 207R00000X | Internal Medicine | Frequently performs management of chronic diseases via audio-only telehealth.
| 208D00000X | General Practice | Provides primary care telephonic follow-up and chronic disease management.
| 207RC0000X | Geriatric Medicine | Often uses audio-only visits for older adults with limited technology access.
| 2084P0800X | Nurse Practitioner | Advanced practice clinicians who commonly deliver and bill for telehealth E/M services.
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|
E11.9 | Type 2 diabetes mellitus without complications | Common chronic condition managed via telephonic follow-up for glucose control and medication adjustment. |
| I10 | Essential (primary) hypertension | Frequently addressed in remote visits for blood pressure symptom review and medication titration.
| R42 | Dizziness and giddiness | Symptom prompting an audio-only evaluation when history and home vitals are obtained.
| R55 | Syncope and collapse | Relevant when patients report near-syncope or fainting episodes during telehealth triage.
| Z71.89 | Other specified counseling | Applicable when counseling on self-management, home monitoring, or medication adherence is provided during the encounter.
| Z76.89 | Persons encountering health services in other specified circumstances | Used for administrative reasons such as telehealth check-ins and follow-up encounters.
| M79.1 | Myalgia | Common symptomatic complaint addressed during audio-only visits for medication management and home care advice.
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|
99213 | Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes | An in-person comparable established patient E/M for straightforward decision making; may be used if patient is seen in person instead of audio-only telehealth. |
| 99443 | Telephone evaluation and management service by a physician or other qualified health care professional; 21-30 minutes of medical discussion | Alternative code for longer non-face-to-face telephone E/M services when time exceeds brief thresholds and payer allows telephone E/M coding.
| 99441 | Telephone E/M by a physician or other qualified health care professional; 5-10 minutes of medical discussion | Used for shorter telephone E/M encounters when time and complexity meet code definitions.
| 99421 | Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes | Used for patient-initiated digital communications (secure messaging) as an asynchronous alternative to audio-only synchronous visits.
| 99091 | Collection and interpretation of physiologic data digitally stored and transmitted by the patient to the physician | Used when remote physiologic monitoring data (e.g., home BP readings) are reviewed and interpreted in addition to the telephonic visit.
| 99072 | Additional supplies, materials, and clinical staff time over and above those usually included for COVID-19 related prevention and control services | May be used per payer guidance for extraordinary protective or communication measures associated with remote care workflows.