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    OpenPayerBilling CodesOther Preventive Medicine ServicesCPT cpt-99422-online-digital-evaluation-management-established-patient-11-20-minutes
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    CPT 99422: Online Digital E/M for Established Patient, 11–20 Minutes

    Medicare pays $32 and commercial payers pay $37 on average nationally for this procedure.

    CPT code 99422 describes an online digital evaluation and management service for an established patient involving synchronous or asynchronous online communication technologies in which a physician or other qualified healthcare professional discusses a health issue and possible treatment or management; this entry covers 11 to 20 minutes of cumulative time over a seven-day period and represents a digital E/M service typically provided in an outpatient or virtual care setting such as an ambulatory clinic or telehealth environment.

    For related coverage guidance, see recent payer policy updates: Pediatric Neurodevelopmental and Autism Spectrum Disorder (ASD) Screening Corporate Medical Policy, Inhaled Nitric Oxide Therapy (for New Mexico Only), Inhaled Nitric Oxide Therapy (for North Carolina Only).

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    National Reimbursement Benchmarks

    Medicare's mean rate for CPT 99422 of $31.6 sits below BUCA's average commercial mean of $37.4, indicating commercial schedules on average pay about $5.8 more than Medicare for this service. Median values for several commercial payers are higher than Medicare's $31 median, suggesting Medicare reimbursement is modest relative to many commercial contracts.

    Dispersion (P75 minus P25) highlights variability across payers: Aetna's spread is $13.1, Blue Cross Blue Shield's spread is $12.2, BUCA's spread is $15.8, Cigna's spread is $26.4, and UnitedHealth Group's spread is $20.7. Cigna shows the widest interquartile dispersion at $26.4, while Blue Cross Blue Shield is the tightest at $12.2, indicating Cigna contracts vary most and Blue Cross Blue Shield contracts are relatively concentrated around the central tendency.

    National Payer Mean Reimbursement Rates

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    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    An established adult patient initiates an asynchronous electronic dialogue with their primary care clinician via a secure patient portal about new or worsening symptoms of headache and fatigue. Over the next seven days the clinician reviews the patient’s messages, prior records, medication list, and recent vital signs, then uses secure messaging and possibly brief video or audio attachments to discuss assessment and management options. The cumulative clinician time spent interacting about the single problem during the seven-day period totals 11–20 minutes, meeting criteria for 99422. Typical workflow: patient sends initial message; clinician reviews chart and messages (including prior visit diagnoses such as R51 or R53.83), documents review and medical decision-making, sends treatment recommendations or safety-netting advice, and closes the episode. Typical sites of service are ambulatory outpatient clinics and virtual care environments accessed via patient portal or telehealth platforms; the service is provided by clinicians in primary care specialties such as family medicine, internal medicine, or general practice and is billed for established patients only. Common payors include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    99421

    Related Modifiers

    7 rows

    ModifierDescriptionWhen to Use
    25CPT modifier 25 indicates that on the same day as another procedure or service, the same physician or other qualified health care professional provided a significant, separately identifiable…- When to apply: Use modifier 25 only on an E/M code to indicate the same provider delivered a significant, separately identifiable E/M service on the same day as another procedure or service — i.e.,…
    95Modifier 95 indicates that a service was provided via synchronous, real‑time audio‑video telehealth rather than in‑person. Per CMS, AAPC and professional associations, append modifier 95 to claim…- Use modifier 95 to indicate a service was furnished via synchronous, real‑time audiovisual telehealth (a live audio‑video conference between patient and provider) rather than in‑person. - Pair…
    93Modifier 93 denotes that a billed service was delivered synchronously via audio-only telecommunications (real-time telephone or other audio-only system). The AMA added modifier 93 in CPT Appendix A…- When to use: Apply modifier -93 when a synchronous, real-time, two-way patient–provider encounter is conducted entirely via audio-only (telephone or other real-time interactive audio-only…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    24Modifier 24 denotes an unrelated evaluation and management (E/M) service performed by the same physician or qualified healthcare professional during a postoperative global period. Per CPT guidance,…- Use modifier 24 when you report an evaluation and management (E/M) service performed by the same physician or same-specialty group during a procedure’s postoperative global period that is unrelated…
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207Q00000X
    207R00000X
    208D00000X
    243U00000X
    225XP0200X
    2084B0040X
    364SG0600X
    163WX0800X

    Related ICD-10-CM Codes

    29 rows

    ICD-10-CM CodeDescription
    A09Infectious gastroenteritis and colitis, unspecified
    B34.9Viral infection, unspecified
    E11.9Type 2 diabetes mellitus without complications
    F32.9Major depressive disorder, single episode, unspecified
    F41.1Generalized anxiety disorder
    G43.909Migraine, unspecified, not intractable, without status migrainosus
    H10.9Unspecified conjunctivitis
    H52.4Presbyopia
    I10Essential (primary) hypertension
    J02.9Acute pharyngitis, unspecified

    Showing 1–10 of 29

    Related Payer Policy Updates

    Specialty: Pediatrics/Neonatology1 / 3

    10 rows

    PolicyPayerEffective Date
    Pediatric Neurodevelopmental and Autism Spectrum Disorder (ASD) Screening Corporate Medical Policybcbsvermont2026-12-01
    Inhaled Nitric Oxide Therapy (for New Mexico Only)UnitedHealthcare2026-10-01
    Inhaled Nitric Oxide Therapy (for North Carolina Only)UnitedHealthcare2026-10-01
    Inhaled Nitric Oxide Therapy (for Pennsylvania Only)UnitedHealthcare2026-10-01
    Inhaled Nitric Oxide Therapy (for Kentucky Only)UnitedHealthcare2026-10-01
    Clinical Policy: NICU Apnea Bradycardia GuidelinesAmbetter Nevada2026-10-01
    DRG Newborn Inpatient Stays - FacilityBlue Cross Blue Shield - Maine2026-10-01
    Pediatric Preventive ScreeningOscar Health2026-10-01
    Infant Nutritional FormulaCigna2026-09-15
    Pediatric Preventive ScreeningBlue Cross Blue Shield - New Mexico2026-09-04

    Related Codes

    CPT-99423-ONLINE-DIGITAL-EVALUATION-ESTABLISHED-PATIENT-21-PLUS-MIN

    CPT 99423: Online Digital E/M for Established Patient, 21+ Minutes

    CPT-99427-COMPLEX-CHRONIC-CARE-MANAGEMENT-CLINICAL-STAFF-30-MIN

    CPT 99427: Complex Chronic Care Management, Additional 30 Minutes

    CPT-99429-PREVENTIVE-MEDICINE-SERVICE-UNSPECIFIED

    CPT 99429: Preventive Medicine Service, Unspecified

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

    Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5–10 minutes
    Lower-tier time-based online E/M; use when cumulative clinician time is 5–10 minutes instead of 11–20 minutes
    99423Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutesHigher-tier time-based online E/M; use when cumulative clinician time during the episode reaches 21 minutes or more
    99441Telephone evaluation and management service provided by a physician to an established patient, parent, or guardian … 5–10 minutesRelated audio-only telephone service of shorter duration; use when the interaction is by telephone and meets time and content criteria
    99442Telephone evaluation and management service provided by a physician to an established patient, parent, or guardian … 11‑20 minutesTelephone equivalent for similar time interval when the service is audio-only rather than online digital messaging
    99443Telephone evaluation and management service provided by a physician to an established patient, parent, or guardian … 21‑30 minutesLonger-duration telephone E/M when cumulative audio-only time exceeds 20 minutes