Medicare Coverage for Virtual Services

What are the differences between virtual services?

	Telehealth E/M	Telephone E/M	E-Visit	Virtual Check-In	Remote Image Evaluation
Modalities	Audio and video (see list of telehealth vendors)	Telephone (audio only)	Online patient portal	Phone, secure email or text message, patient portal	Store and forward asynchronous technology
Service description	Interactive E/M service via real-time, two-way video call	Patient-initiated E/M service via real-time telephone call	Patient-initiated E/M service via online patient portal	Brief assessment to determine whether an in-person office visit or other service is required	Evaluation and interpretation of a pre-recorded video or image provided by a patient
Eligible providers	Physician, physician assistant, nurse practitioner	Physician, physician assistant, nurse practitioner, other qualified nonphysician provider	Physician, physician assistant, nurse practitioner, other qualified nonphysician provider	Physician, physician assistant, nurse practitioner	Physician, physician assistant, nurse practitioner
Patient relationship	New and established patients	New and established patients (new patients allowed during PHE)	New and established patients (new patients allowed during PHE)	New and established patients (new patients allowed during PHE)	New and established patients (new patients allowed during PHE)
Codes	CPT codes 99201-99205 (new patients) CPT codes 99211-99215 (established patients)	CPT codes 99441-99443 (for MDs/DOs, PAs, NPs) CPT codes 98966-98968 (for other qualified NPPs)	CPT codes 99421-99423 (for MDs/DOs, PAs, NPs) HCPCS codes G2061-G2063 (for other qualified NPPs)	HCPCS code G2012	HCPCS code G2010
Telehealth Modifier	95 (telemedicine) CS (E/M service related to COVID-19 testing)*	N/A	N/A	N/A	N/A

*Physicians should append both modifiers 95 and CS on applicable claim lines to identify the service as subject to the cost-sharing wavier for COVID-19 testing-related services to get 100% of the Medicare-approved amount. Modifier CS may be used for services furnished on March 18, 2020, and through the end of the PHE.

Virtual Service Codes

Telehealth Office/Outpatient Evaluation and Management Visits

Synchronous audio AND visual evaluation and management visit between a patient and clinician

CPT Code	Description	Time*	Medical Decision-Making
99201	Office or other outpatient visit for the evaluation and management of a new patient	N/A	Straightforward
99202	Office or other outpatient visit for the evaluation and management of a new patient	15–29 minutes	Straightforward
99203	Office or other outpatient visit for the evaluation and management of a new patient	30–44 minutes	Low complexity
99204	Office or other outpatient visit for the evaluation and management of a new patient	45–59 minutes	Moderate complexity
99205	Office or other outpatient visit for the evaluation and management of a new patient	60–74 minutes	High complexity
99211	Office or other outpatient visit for the evaluation and management of an established patient	N/A	N/A
99212	Office or other outpatient visit for the evaluation and management of an established patient	10–19 minutes	Straightforward
99213	Office or other outpatient visit for the evaluation and management of an established patient	20–29 minutes	Low complexity
99214	Office or other outpatient visit for the evaluation and management of an established patient	30–39 minutes	Moderate complexity
99215	Office or other outpatient visit for the evaluation and management of an established patient	40–54 minutes	High complexity

*NOTE: During the PHE, telehealth E/M code selection can be based on medical decision-making or time alone. When selecting a code based on time, use total time of the physician and/or qualified health care professional on the date of the encounter.

Information about other telehealth services covered by Medicare during the PHE can be found at the following link:

List of Covered Medicare Telehealth Services (During COVID-19 PHE)

Telephone Evaluation and Management Services

Evaluation and management visits via audio-only telephone communications

CPT Code	Description
	Physician/QHP Services*
99441	Telephone evaluation and management service by a physician or other qualified health care professional (QHP) who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5–10 minutes of medical discussion
99442	11-20 minutes of medical discussion
99443	21-30 minutes of medical discussion
	Qualified Nonphysician Health Care Professional Services
98966	Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment
98967	11-20 minutes of medical discussion
98968	21-30 minutes of medical discussion

*NOTE: During the PHE, payment rates for audio-only telephone E/M codes 99441-99443 will be increased to match those of established patient office/outpatient E/M codes 99212-99214.

E-Visits

Communication between a patient and a physician or qualified nonphysician practitioner through an online patient portal or secure email

CPT/HCPCS Code	Description
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
99422	11-20 minutes
99423	21 or more minutes
98970	Qualified nonphysician health care professional online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes
98971	11-20 minutes
98972	21 or more minutes
G2061	Qualified nonphysician health care professional online assessment, for an established patient, for up to seven days, cumulative time during the 7 days; 5-10 minutes
G2062	11-20 minutes
G2063	21 or more minutes

Virtual Check-Ins

Brief check-in via telecommunications technology to decide whether an office visit or other service is needed

HCPCS Code	Description
G2012	Brief communication technology-based service, e.g., virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion

G2012

Brief communication technology-based service, e.g., virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion

Remote Image Evaluation

Remote review of video and/or images submitted by a patient, with interpretation and report

HCPCS Code	Description
G2010	Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment