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.

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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.

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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.

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Get alerted when payer policies referencing 99422 are released or updated.

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National Reimbursement Benchmarks

National Payer Mean Reimbursement Rates

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

Related Modifiers

7 rows

Modifier	Description	When to Use
25	CPT 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.,…
95	Modifier 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…
93	Modifier 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…
52	Modifier ‑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…
53	Modifier 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…
24	Modifier 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…
22	Modifier –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	Specialty	Notes
207Q00000X	Family Medicine Physician	Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadt…
207R00000X	Internal Medicine Physician	A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults…
208D00000X	General Practice Physician	A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.
243U00000X	Radiology Practitioner Assistant	A Radiology Practitioner Assistant (RPA) is a health professional certified as a registered radiographer with the American Registry of Radiologic Tech…
225XP0200X	Pediatric Occupational Therapist	Occupational therapists provide services to infants, toddlers and children who have or who are at risk for developmental delays or disabilities. Occup…
2084B0040X	Behavioral Neurology & Neuropsychiatry Physician	Behavioral Neurology & Neuropsychiatry is a medical subspecialty involving the diagnosis and treatment of neurologically based behavioral issues.
364SG0600X	Gerontology Clinical Nurse Specialist	Physician Assistants & Advanced Practice Nursing Providers · Clinical Nurse Specialist
163WX0800X	Orthopedic Registered Nurse	Nursing Service Providers · Registered Nurse

Related ICD-10-CM Codes

29 rows

ICD-10-CM Code	Description
A09	Infectious gastroenteritis and colitis, unspecified
B34.9	Viral infection, unspecified
E11.9	Type 2 diabetes mellitus without complications
F32.9	Major depressive disorder, single episode, unspecified
F41.1	Generalized anxiety disorder
G43.909	Migraine, unspecified, not intractable, without status migrainosus
H10.9	Unspecified conjunctivitis
H52.4	Presbyopia
I10	Essential (primary) hypertension
J02.9	Acute pharyngitis, unspecified

Showing 1–10 of 29

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.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.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.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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Clinical & Coding Specifications

Clinical Context

Related CPT Codes

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

Related Modifiers

7 rows

Modifier	Description	When to Use
25	CPT 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.,…
95	Modifier 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…
93	Modifier 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…
52	Modifier ‑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…
53	Modifier 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…
24	Modifier 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…
22	Modifier –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	Specialty	Notes
207Q00000X	Family Medicine Physician	Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadt…
207R00000X	Internal Medicine Physician	A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults…
208D00000X	General Practice Physician	A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.
243U00000X	Radiology Practitioner Assistant	A Radiology Practitioner Assistant (RPA) is a health professional certified as a registered radiographer with the American Registry of Radiologic Tech…
225XP0200X	Pediatric Occupational Therapist	Occupational therapists provide services to infants, toddlers and children who have or who are at risk for developmental delays or disabilities. Occup…
2084B0040X	Behavioral Neurology & Neuropsychiatry Physician	Behavioral Neurology & Neuropsychiatry is a medical subspecialty involving the diagnosis and treatment of neurologically based behavioral issues.
364SG0600X	Gerontology Clinical Nurse Specialist	Physician Assistants & Advanced Practice Nursing Providers · Clinical Nurse Specialist
163WX0800X	Orthopedic Registered Nurse	Nursing Service Providers · Registered Nurse

Related ICD-10-CM Codes

29 rows

ICD-10-CM Code	Description
A09	Infectious gastroenteritis and colitis, unspecified
B34.9	Viral infection, unspecified
E11.9	Type 2 diabetes mellitus without complications
F32.9	Major depressive disorder, single episode, unspecified
F41.1	Generalized anxiety disorder
G43.909	Migraine, unspecified, not intractable, without status migrainosus
H10.9	Unspecified conjunctivitis
H52.4	Presbyopia
I10	Essential (primary) hypertension
J02.9	Acute pharyngitis, unspecified

Showing 1–10 of 29

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.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.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.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 powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

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CPT 99422: Online Digital E/M for Established Patient, 11–20 Minutes

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National Reimbursement Benchmarks

OpenPayer

CPT 99422: Online Digital E/M for Established Patient, 11–20 Minutes

Sign up for cpt 99422 policy alerts

National Reimbursement Benchmarks

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Codes

References

CPT 99422: Online Digital E/M for Established Patient, 11–20 Minutes

Sign up for cpt 99422 policy alerts

National Reimbursement Benchmarks

CPT 99422: Online Digital E/M for Established Patient, 11–20 Minutes

Sign up for cpt 99422 policy alerts

National Reimbursement Benchmarks

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Codes

What clinical scenario does CPT 99422 describe?

For what patient types and settings is 99422 typically used?

How does 99422 relate to CPT codes 99421 and 99423?

When might related telephone E/M codes (99441–99443) be more appropriate than 99422?

What diagnoses are commonly managed via 99422 in the provided example?

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Codes

What clinical scenario does CPT 99422 describe?

For what patient types and settings is 99422 typically used?

How does 99422 relate to CPT codes 99421 and 99423?

When might related telephone E/M codes (99441–99443) be more appropriate than 99422?

What diagnoses are commonly managed via 99422 in the provided example?

References