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    OpenPayerBilling CodesOther Preventive Medicine ServicesCPT cpt-99423-online-digital-evaluation-established-patient-21-plus-min
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    CPT 99423: Online Digital E/M for Established Patient, 21+ Minutes

    Medicare pays $50 and commercial payers pay $58 on average nationally for this procedure.

    CPT code 99423 describes an online digital evaluation and management service for an established patient where a physician or other qualified healthcare professional uses online communication technologies to discuss a health issue and possible treatment or management, covering 21 or more minutes of cumulative time delivered over a period of up to seven days; service type: online digital evaluation and management (E/M) consultation; typical site of service: virtual/telehealth or other remote outpatient setting using secure digital communication tools.

    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

    National commercial averages exceed Medicare for CPT 99423: Blue Cross Blue Shield, Cigna, UnitedHealth Group and BUCA all have mean rates above Medicare’s mean of $50.2, with BUCA averaging $58.4 and Medicare averaging $50.2, a gap of $8.2 favoring the commercial average. Cigna and UnitedHealth Group show the highest mean rates ($71.4 and $71.7 respectively), while Aetna and Blue Cross Blue Shield sit closer to Medicare’s level.

    Dispersion across payers varies: compute P75–P25 to assess spread. Aetna’s interquartile range is $13.9, Blue Cross Blue Shield is $17.8, BUCA is $24.4, Cigna is $42.7, and UnitedHealth Group is $38.2. Cigna and UnitedHealth Group exhibit the widest IQRs, indicating greater variability, while Aetna is the tightest among the listed payers.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    An established adult patient initiates an online, asynchronous or synchronous digital exchange with their primary care clinician regarding new or ongoing symptoms of fatigue and health concerns after a recent employment physical. Over a 7-day reporting period the clinician documents and spends a cumulative time of 21 or more minutes engaging via secure patient portal messages, video visit, and/or telephone, discussing history, reviewing prior exam findings, ordering or reviewing basic labs, and outlining potential management or need for in‑person evaluation. Typical workflow: intake message from patient describing fatigue and request for medical certification; clinician reviews the patient chart (past examination findings and recent encounter codes such as Z00.00/Z00.01), requests targeted labs, communicates differential consideration (including Z71.1 when no diagnosis is established), issues or documents guidance for medical certificate requests (Z02.79), and documents total cumulative time ≥21 minutes during the 7‑day period to bill 99423. Typical site of service is ambulatory outpatient/telehealth (virtual clinic or secure patient portal). Service type is an online digital evaluation and management service for an established patient provided by Family Medicine or Internal Medicine clinicians (telemedicine/virtual care).

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure

    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…
    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…
    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…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207QA0000X
    207R00000X
    171100000X
    1835C0206X
    2085D0003X
    2278P1006X
    207RT0003X
    333600000X

    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-99422-ONLINE-DIGITAL-EVALUATION-MANAGEMENT-ESTABLISHED-PATIENT-11-20-MINUTES

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

    99421Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5–10 minutesLower time tier for similar online E/M services; use when total cumulative time is 5–10 minutes during the 7‑day period instead of 99423.
    99422Online digital evaluation and management service, for an established patient, for up to 7 days cumulative time during the 7 days; 11–20 minutesMid time tier for the same service; use when cumulative time is 11–20 minutes during the 7‑day period.