Telemedicine – First Quarter (2025) Update
Congress stepped in and passed the American Relief Act 0f 2025, temporarily extending the PHE telemedicine criteria, through the first quarter of 2025.
Although the AMA (CPT) created all new Telemedicine codes for 2025, CMS (Medicare) is only recognizing one of them. Therefore, there will be two ways to code, depending on whether your patient is Medicare vs. private payer not following Medicare rules. Private payers, of course, may determine their own Telemedicine Coverage Criteria.
CMS (Centers for Medicare and Medicaid Services) is recommending continued use of E/M codes with the appropriate modifier to distinguish the type of telemedicine service provided.
Telemedicine Modifiers to be used with E/M Codes:
95 – Audio/Video (Synchronous Telemedicine Service rendered via a Real-Time Interactive Audio and Video Telecommunication System)
93 – Audio-only (Synchronous Telemedicine Service rendered via Telephone or Other Real-Time Interactive Audio-only Telecommunication System)
- CMS expects audio-visual technology unless the patient lacks video capability or declines video use. Document the exception for telephone-only visits.
The American Relief Act of 2025 also extends the following places of service.
Place of Service Options:
02 – Other than Home
10 – Home
For UT Health – Houston providers, we have created an at-a-glance chart to help visualize Medicare vs. Private Pay coding options (link below).
Telemedicine (Telemedicine and Non-Face-to-Face Chart (internal link)
(17) New Codes in the E/M CPT section (PRIVATE PAYERS ONLY – CMS does not recognize)
- Audio-video telemedicine visits for new and established patients
- New Patients (98000 – 98003)
- Established Patients (98004 – 98007)
- Audio-only telemedicine (new and established) will replace existing telephone-only codes
- New Patients (98008 – 98011)
- Established Patients (98012 – 98015)
- CAUTION: CMS is not recognizing these CPT codes. How will we report these? E/M? There are specific requirements for Medicare patients (1) audio-only services (-93 modifier) and (2) provider must have A/V even if patient doesn’t or declines video. Document. Document. Document.
- Brief communication technology-based service (e.g., virtual check-in)
- New CPT Code 98016 replaces G2012
- This is the only new CPT code for telemedicine CMS is recognizing
Resources
American Relief Act of 2025 (SEC. 3207. Extension of certain telehealth flexibilities)
Federal Register – Final Rule (pg. 80)
Haugen Group Article
Texas Medical Association (TMA) – Updated Telemedicine Chart