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    v1.0.28
    OpenPayerBilling CodesOther ServicesHCPCS hcpcs-m1426-telehealth-encounter-virtual-visit
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    HCPCS Level II M1426: Telehealth Encounter

    HCPCS Level II code M1426 denotes encounters conducted via telehealth, representing remote clinical patient-provider interactions delivered as telemedicine/telehealth services; the service type is telehealth encounter and the typical site of service is remote/virtual (patient location outside the provider’s facility), used to document and bill virtual visit encounters performed through synchronous audiovisual communication.

    For related coverage guidance, see recent payer policy updates: Interferential Stimulation Devices (for home use), Durable Medical Equipment (DME): Tumor Treating Fields (Alternating Electric Field Therapy) Medical Guideline, Durable Medical Equipment (DME): Bone Growth Stimulators Medical Guideline.

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    Clinical & Coding Specifications

    Clinical Context

    A patient with a non-urgent follow-up for a chronic condition connects with their primary care clinician via a scheduled telehealth video visit billed under M1426. The patient is an adult with controlled hypertension and type 2 diabetes, reporting intermittent elevated home blood pressures and asking medication clarification. Prior to the visit, the medical assistant verifies patient identity, documents consent for telehealth, updates medication list and recent vitals entered by the patient (home blood pressure readings, weight, and glucose logs). The clinician conducts the encounter via secure video, reviews the home monitoring data, performs a focused virtual assessment (visual inspection for edema, discussion of symptoms), adjusts antihypertensive dosing, and documents the encounter in the electronic health record. The clinician documents time, modality, patient location, and that the visit was delivered via telehealth for billing with M1426. Typical workflow steps include scheduling and consent, pre-visit data collection, synchronous video encounter, documentation of clinical decision-making and care plan, and electronic prescribing or patient instructions sent after the visit.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    99213Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutesCommonly performed via telehealth for routine chronic condition follow-up visits preceding or concurrent with billing under telehealth encounter codes.
    99214Office or other outpatient visit for the evaluation and management of an established patient, typically 25 minutesUsed for more complex telehealth follow-up visits requiring moderate-complexity decision making.
    99421Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time 5-10 minutesMay be used for asynchronous patient-initiated digital communications that complement synchronous telehealth visits.
    99443Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time 21 or more minutesUsed for extended virtual management outside of synchronous video encounters.
    99091Collection and interpretation of physiologic data digitally stored and transmitted by the patient, requiring a minimum of 30 minutes of timeUsed when remote patient monitoring data (e.g., home blood pressures, glucose logs) are collected and reviewed as part of telehealth care.

    Related Modifiers

    6 rows

    ModifierDescriptionWhen to Use
    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…
    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.,…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
    77Modifier 77 indicates that a previously performed procedure or service was legitimately repeated by a different physician or other qualified health care professional. The AMA’s CPT definition…- Use modifier 77 when a basic procedure or service already performed is repeated by a different physician or other qualified health care professional (for example, a second provider independently…
    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 CodeSpecialtyNotes
    207Q00000XFamily Medicine PhysicianFamily 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…
    207R00000XInternal Medicine PhysicianA physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults…
    207L00000XAnesthesiology PhysicianAn anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
    208D00000XGeneral Practice PhysicianA physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.
    363L00000XNurse Practitioner(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision mak…
    207SM0001XMolecular Genetic Pathology (Medical Genetics) PhysicianA board certified subspecialty, the molecular genetic pathologist is expert in the principles, theory and technologies of molecular biology and molecu…
    101Y00000XCounselorA provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and …
    202D00000XIntegrative Medicine PhysicianA physician who specializes in the treatment of the whole person through prevention and treatment based on medical evidence. Integrative medicine cons…

    Related ICD-10-CM Codes

    26 rows

    ICD-10-CM CodeDescription
    E11.9Type 2 diabetes mellitus without complications
    F32.9Major depressive disorder, single episode, unspecified
    F33.1Major depressive disorder, recurrent, moderate
    F41.9Anxiety disorder, unspecified
    G43.909Migraine, unspecified, not intractable, without status migrainosus
    G47.00Insomnia, unspecified
    H10.9Unspecified conjunctivitis
    I10Essential (primary) hypertension
    I63.9Cerebral infarction, unspecified
    J06.9Acute upper respiratory infection, unspecified

    Showing 1–10 of 26

    Related Payer Policy Updates

    Specialty: Durable Medical Equipment (DME)1 / 2

    5 rows

    PolicyPayerEffective Date
    Interferential Stimulation Devices (for home use)Moda Health2026-10-01
    Durable Medical Equipment (DME): Tumor Treating Fields (Alternating Electric Field Therapy) Medical GuidelineWPS Health Insurance2026-10-01
    Durable Medical Equipment (DME): Bone Growth Stimulators Medical GuidelineWPS Health Insurance2026-10-01
    General Durable Medical Equipment (DME) Medical GuidelineWPS Health Insurance2026-10-01
    Prior Authorization for Durable Medical Equipment (DME)Blue Cross Blue Shield - Rhode Island2026-10-01

    Related Codes

    HCPCS-LEVEL-II-M1252-AMBULATORY-PALLIATIVE-CARE-SURVEY-NONCOMPLETION

    HCPCS M1252: Ambulatory Palliative Care Patient Experience Survey Incomplete

    HCPCS-LEVEL-II-M1255-POSITIVE-PREGNANCY-TEST-NON-OB-VISIT

    HCPCS Level II M1255: Visit with Positive Pregnancy Test, Not Established OB

    HCPCS-LEVEL-II-M1278-ELEVATED-BLOOD-PRESSURE-WITH-DOCUMENTED-FOLLOW-UP

    HCPCS Level II M1278: Elevated or Hypertensive Blood Pressure Reading Documented

    HCPCS-LEVEL-II-M1292-FRAILTY-WITH-ADVANCED-ILLNESS-66-PLUS

    HCPCS M1292: Frailty with Advanced Illness, Age 66 and Older

    HCPCS-LEVEL-II-M1300-INFLUENZA-IMMUNIZATION-NOT-ADMINISTERED

    HCPCS Level II M1300: Influenza Immunization Not Administered, Documented Reason

    HCPCS-LEVEL-II-M1326-HYPOTONY-EVALUATION-MANAGEMENT

    HCPCS Level II M1326: Patients with a Diagnosis of Hypotony

    HCPCS-LEVEL-II-M1356-PATIENTS-WHO-DIED-DURING-MEASUREMENT-PERIOD

    HCPCS Level II M1356: Patients Who Died During Measurement Period

    HCPCS-LEVEL-II-M1375-RA-ADDITIONAL-ENCOUNTER-90-DAYS

    HCPCS Level II M1375: Additional Rheumatoid Arthritis Encounter

    HCPCS-LEVEL-II-M1384-PATIENTS-DIED-PERFORMANCE-PERIOD

    HCPCS Level II M1384: Patient Death During Performance Period

    HCPCS-LEVEL-II-M1490-PATIENT-STATUS-NOT-DOCUMENTED

    HCPCS Level II M1490: Patient Status Not Documented

    Showing 1–10 of 356

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    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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