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    v1.0.28
    OpenPayerBilling CodesOther ServicesHCPCS hcpcs-m1436-telehealth-encounter-remote-service
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    HCPCS Level II M1436: Telehealth Encounter

    HCPCS Level II code M1436 represents encounters conducted via telehealth and is used to report remote clinical visits delivered through synchronous telecommunication technologies; the service type is telehealth/virtual patient encounter and the typical site of service is a remote/telehealth setting (patient and provider not co-located).

    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 42-year-old patient with well-controlled type 2 diabetes requests a follow-up visit for medication review and symptom check after a recent change in therapy. The clinician schedules a live, interactive audio-video telehealth visit using a secure platform. Prior to the encounter, the medical assistant verifies identity, documents consent for telehealth, confirms the patient’s location and payer, and uploads recent home blood glucose readings to the EHR. During the synchronous visit the clinician reviews symptoms, vitals reported by the patient (home glucose values and blood pressure), assesses adherence and side effects, adjusts medication dosing, and documents the plan. Coding staff assign the appropriate telehealth encounter billing code M1436 to capture the telehealth service, append any applicable modifiers per payer rules, and submit with the diagnosis code for the visit. Common payors for similar services include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    99213Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutesCommon telehealth-equivalent E/M level for routine follow-up conducted via telehealth and often billed in conjunction with telehealth encounter coding when payer allows
    99441Telephone evaluation and management service provided by a physician to an established patient, 5-10 minutes of medical discussionUsed when audio-only telephonic management occurs instead of video telehealth
    99421Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 daysUsed for secure asynchronous patient-initiated digital assessment when the telehealth workflow includes messaging
    96127Brief emotional/behavioral assessment (e.g., depression inventory)Frequently used adjunctively in telehealth visits when screening tools are administered remotely
    36415Collection of venous blood by venipunctureOrdered before or after a telehealth visit if laboratory monitoring is required as part of remote management

    Related Modifiers

    5 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…
    26Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
    P2Modifier P2 denotes an ASA Physical Status II — a patient with mild systemic disease. Per AMA/AAPC, examples include well-controlled hypertension or diabetes, mild obesity (BMI 30–40), current smoker…- When to use: Append modifier -P2 to anesthesia CPT codes (00100–01999) when the anesthesia provider documents the patient has mild systemic disease (ASA Physical Status II) — for example…

    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.
    363A00000XPhysician AssistantA physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and…
    125Q00000XOral Medicine DentistryOral Medicine is the specialty of dentistry responsible for the oral health care of medically complex patients and for the diagnosis and management of…
    2279P1006XPulmonary Function Technologist Registered Respiratory TherapistAn individual who is trained and qualified to perform pulmonary diagnostic tests. In the course of conducting these tests, the Pulmonary Function Tec…
    171100000XAcupuncturistAn acupuncturist is a person who performs ancient therapy for alleviation of pain, anesthesia and treatment of some diseases. Acupuncturists use long,…

    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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