98013 CPT Audio-Only E/M — Reimbursement & Policy | OpenPayer

Summary & Overview

CPT 98013: Audio-Only E/M Visit for Established Patients, Low MDM

CPT code 98013 represents an established patient evaluation and management visit provided using synchronous audio-only technology. The code captures encounters with more than 10 minutes of medical discussion, low medical decision making, or at least 20 minutes of total clinician time on a single date. As audio-only telehealth remains an important access modality, this code reflects national attention to remote care options for patients without video capability.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise review of what the code denotes, how major payers treat audio-only visits, and the practical clinical context for using the code. The publication covers benchmarks where available, recent policy updates affecting audio-only telehealth billing, and considerations for documentation and coding consistency.

This summary provides clinicians, billing staff, and policy analysts with a clear, national-level reference for CPT code 98013, clarifying the service definition, typical settings of care, and the topics addressed in the full publication.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare98013CPTtelehealthaudio-onlyevaluation-and-managementestablished-patientremote-caremedical-decision-making

Billing Code Overview

CPT code 98013 describes an established patient evaluation and management visit delivered via synchronous audio-only technology. The service requires more than 10 minutes of medical discussion, involves low medical decision making, and/or the clinician documents 20 or more minutes of total time spent on the encounter on a single date.

Service type: Audio-only telehealth evaluation and management for established patients

Typical site of service: Remote/telehealth (audio-only) delivery to the patient's location

If additional billing elements or payer-specific guidance are needed, those details are covered in other sections.

Clinical & Coding Specifications

Clinical Context

A patient with a previously established primary care relationship calls their clinician’s office complaining of worsening cough and low-grade fever. The clinician triages the request and schedules a synchronous audio-only telephone visit because the patient lacks reliable video access. The clinician conducts a focused evaluation lasting more than 10 minutes of medical discussion, documents subjective history, reviews recent medications and allergies, assesses symptoms, and provides management advice including symptomatic treatment and return precautions. The encounter involves low medical decision making (e.g., assessment and adjustment of current therapy, reinforcement of self-care) and the clinician documents a total encounter time of 20 minutes spent on the date of service, including telephone assessment, review of records, and coordination of care. Typical workflow steps: intake and verification of identity and consent, focused history and symptom review, clinical assessment and counseling, documentation of time and medical decision making, and billing under 98013 with any required payer-specific modifier (for example 95 or telehealth-specific payor modifiers) and appropriate diagnosis code(s) representing the acute respiratory condition.

Coding Specifications

Modifier	Description	When to Use
`95`	Synchronous telemedicine service rendered via real-time interactive audio and video

CPT 98014: Established Patient E/M via Audio-Only, Moderate Complexity

CPT-98012-AUDIO-ONLY-ESTABLISHED-PATIENT-E-M

CPT 98012: Audio-only E/M Visit for Established Patient

CPT-98015-AUDIO-ONLY-EVALUATION-ESTABLISHED-PATIENT-HIGH-DECISION-MAKING

CPT 98015: Audio-Only E/M for Established Patients, High Complexity

Taxonomy Code	Specialty	Notes
208000000X	Family Medicine	Primary care clinicians commonly perform telephonic follow-up and management
208100000X	Internal Medicine	Internists provide ongoing management for chronic and acute conditions via telephone
208D00000X	Pediatrics	Pediatricians perform audio-only visits for established pediatric patients
207Q00000X	Emergency Medicine	Emergency clinicians may use `98013` for post-discharge or follow-up audio encounters
2083P0800X	Nurse Practitioner	Nurse practitioners provide established-patient audio-only evaluation and management

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`J06.9`	Acute upper respiratory infection, unspecified	Common diagnosis for audio-only evaluation of cough, congestion, and mild fever
`J02.9`	Acute pharyngitis, unspecified	Frequently managed via telephone for symptom guidance and return precautions
`J20.9`	Acute bronchitis, unspecified	Low-complexity respiratory complaint that often qualifies for an audio-only visit
`R05`	Cough	Symptom code used when a specific infectious diagnosis is not established during the call
`J00`	Acute nasopharyngitis (common cold)	Typical reason for symptom management via audio-only telecommunication

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	Common in-person alternative for a low-complexity established patient visit when face-to-face evaluation is appropriate
`99441`	Telephone evaluation and management service by a physician or other qualified health care professional, 5-10 minutes of medical discussion	Shorter-duration telephone service that may be billed when total medical discussion is under 11 minutes and thus does not meet `98013` time threshold
`99442`	Telephone E/M by physician, 11-20 minutes of medical discussion	Overlaps with duration-based telephone services; use when audio-only discussion meets 11–20 minute range depending on payer rules
`99091`	Collection and interpretation of physiologic data digitally stored and transmitted by the patient to the physician	Can be performed in conjunction with remote telephonic management when physiologic data are reviewed
`99495`	Transitional care management, moderate complexity	May be used in the post-discharge period when the clinician provides timely post-discharge follow-up that includes audio-only contact as part of the TCM workflow

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