CPT 98015 Audio-Only E/M Reimbursement & Policy | OpenPayer

Summary & Overview

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

CPT code 98015 represents an established-patient evaluation and management visit delivered via synchronous audio-only telehealth. The service is defined by more than 10 minutes of medical discussion and either high medical decision making or 40 or more minutes of total provider time on a single date. Nationally, this code matters because it formalizes billing for higher-complexity audio-only encounters, affecting access to telemedicine for patients without video capability and shaping payer coverage policies for remote care.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what CPT code 98015 represents, how it applies to remote/telehealth service delivery, and the typical clinical contexts that may generate its use. The publication covers benchmarking elements, recent policy and coverage considerations relevant to audio-only E/M services, and clinical context around encounter complexity and time-based coding. Data not available in the input is noted where applicable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 98015telehealthaudio-onlyevaluation and managementestablished patienttime-based codinghigh medical decision makingremote care

Billing Code Overview

CPT code 98015 describes an established patient evaluation and management visit delivered using synchronous audio-only technology. The service requires more than 10 minutes of medical discussion and involves high medical decision making, and/or the provider spends 40 or more minutes of total time on the encounter on a single date.

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

Typical site of service: Remote/telehealth (audio-only), provided to the patient in a non-clinic location such as their home or other remote setting

Clinical & Coding Specifications

Clinical Context

An established adult patient with chronic congestive heart failure and multiple recent medication changes requests an audio-only visit for symptom worsening, medication reconciliation, and urgent adjustment of therapy. The patient has limited internet access and cannot complete a video visit. The nurse schedules a synchronous telephone encounter with the primary care cardiology advanced practice provider. The provider conducts a focused history of present illness, reviews home weight logs and blood pressure readings, assesses symptom severity (dyspnea at rest, orthopnea, edema), reviews recent laboratory results available in the EHR, and makes high-level medication decisions including titration of diuretics and ordering same-day laboratory monitoring. The visit involves prolonged clinical discussion exceeding 10 minutes, with the provider spending a total of 40 or more minutes on the encounter date including pre- and post-encounter work (reviewing records, messaging, and care coordination). Documentation includes reason for audio-only format, consent for telephone care, detailed history, medical decision making that supports high complexity, time spent on the date, and any orders or prescriptions placed. Typical payors include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare. Typical site of service is the patient’s home or another non-facility location where the patient is located during the audio-only encounter.

Coding Specifications

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

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

CPT-98014-ESTABLISHED-PATIENT-AUDIO-ONLY-EM-MODERATE-COMPLEXITY

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

CPT-98013-AUDIO-ONLY-EVALUATION-ESTABLISHED-PATIENT

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

Taxonomy Code	Specialty	Notes
`207P00000X`	Family Medicine	Primary care physicians frequently provide audio-only telemedicine E/M for chronic disease management.
`208D00000X`	Cardiology	Cardiologists or cardiology APPs manage complex heart failure follow-up via audio-only encounters when appropriate.
`363L00000X`	Nurse Practitioner	Nurse practitioners commonly deliver telephonic E/M visits for medication management and care coordination.
`3086S0123X`	Physician Assistant	Physician assistants provide synchronous telephone evaluations and management under supervising physician arrangements.
`207R00000X`	Internal Medicine	Internists manage complex chronic conditions and perform high medical decision making during audio-only visits.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`I50.33`	Acute on chronic systolic (congestive) heart failure	Common reason for audio-only urgent management and medication titration in follow-up encounters.
`I50.32`	Chronic systolic (congestive) heart failure	Ongoing management with frequent medication adjustments and monitoring via telephone encounters.
`I10`	Essential (primary) hypertension	Frequently coexists and is reviewed during medication reconciliation and clinical decision making.
`E11.9`	Type 2 diabetes mellitus without complications	Common comorbidity requiring medication review and lab monitoring discussed during the visit.
`R06.02`	Shortness of breath	Symptom prompting urgent audio-only evaluation and treatment adjustments.
`R60.0`	Localized edema	Symptom assessed during heart failure and other volume-overload management via phone.
`Z71.83`	Encounter for dietary counseling and surveillance	Counseling and self-management education often provided during extended telephone encounters.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99441`	Telephone evaluation and management service by a physician or other qualified health care professional, 5-10 minutes of medical discussion	Use for shorter audio-only telephone E/M encounters; lower-intensity alternative when total discussion time is less than required for `98015`.
`99442`	Telephone evaluation and management service by a physician or other qualified health care professional, 11-20 minutes of medical discussion	Use for moderate-length telephone E/M visits when time meets `99442` thresholds but does not meet `98015` complexity/time requirements.
`99443`	Telephone evaluation and management service by a physician or other qualified health care professional, 21-30 minutes of medical discussion	Use for longer telephone E/M visits up to 30 minutes when complexity/time fall short of `98015` criteria.
`99213`	Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes	Use when an in-person established patient visit is performed instead of an audio-only encounter; may be billed on same day with appropriate modifiers when separate and distinct.
`99091`	Collection and interpretation of physiologic data digitally stored and/or transmitted by the patient to the physician or other qualified health care professional	Use adjunctively when remote physiologic monitoring data are reviewed in conjunction with the audio-only visit.

OpenPayer