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    v1.0.28
    OpenPayerBilling CodesOther ServicesHCPCS hcpcs-m1437-telehealth-encounter
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    HCPCS Level II M1437: Telehealth Encounter

    HCPCS Level II code M1437 designates encounters conducted via telehealth and represents remote clinical services delivered to a patient using telecommunication technology; service type: telehealth visit; typical site of service: patient location remote from the provider (telehealth/virtual care).

    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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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient scenario involves an established adult patient with a chronic condition (for example, hypertension, diabetes mellitus, or anxiety) who needs routine follow-up, medication management, or triage. The patient contacts the ambulatory clinic and is scheduled for a telehealth encounter conducted by the treating clinician using synchronous audio-video technology. During the visit the clinician reviews vitals and home-monitored data, assesses symptoms, reconciles medications, updates the problem list, and documents plan of care. The clinical workflow includes patient check-in and identity verification, consent for telehealth, completion of the virtual visit with history and medical decision making, and electronic documentation and ordering (e.g., labs, imaging, prescriptions). The encounter may result in continuation of current therapy, medication adjustments, ordering of tests, or scheduling of an in-person follow-up if required. Typical sites of service are outpatient clinics and the patient’s home via telehealth platforms. The service type is a synchronous telehealth evaluation and management encounter billed under HCPCS Level II code M1437 for encounters conducted via telehealth.

    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 used for a moderate complexity telehealth follow-up E/M visit performed via M1437 telehealth encounter.
    99441Telephone evaluation and management service by a physician or other qualified health care professional, 5-10 minutes of medical discussionMay be used when audio-only telephonic medical management occurs as part of the patient’s remote care when audiovisual telehealth is not available.
    99421Online digital E/M service, for an established patient, cumulative time during the 7 daysUsed for asynchronous online patient portal management that may complement a synchronous telehealth encounter.
    99091Collection and interpretation of physiologic data digitally stored and/or transmitted by the patient to the physicianOften used when home-monitored data (e.g., blood pressure, glucose) are reviewed as part of telehealth management.
    G2012Brief communication technology-based service (virtual check-in)Used for short check-ins that may triage whether a full telehealth visit billed under M1437 is needed.

    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…
    33Modifier 33 was created by the American Medical Association in response to the Affordable Care Act to identify services provided for preventive intent. It is appended to CPT/HCPCS codes that could be…- Use modifier -33 when a CPT/HCPCS service that can be billed as either preventive or diagnostic/treatment is provided with preventive intent and aligns with USPSTF A or B recommendations or other…

    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…
    363L00000XNurse Practitioner(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision mak…
    101Y00000XCounselorA provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and …
    226000000XRecreational Therapist AssistantRecreational Therapist Assistants work in support of or assistant to Recreational Therapists treating patients with disabilities, injuries, and illnes…
    163WS0200XSchool Registered NurseNursing Service Providers · Registered Nurse
    208200000XPlastic Surgery PhysicianA plastic surgeon deals with the repair, reconstruction or replacement of physical defects of form or function involving the skin, musculoskeletal sys…

    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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