2025 Telemedicine E/M Codes: A Complete Guide for Accurate Billing and Reimbursement

Telemedicine continues to reshape the way healthcare is delivered. With increased adoption and regulatory support, payers and providers are adjusting to new rules for coding and billing virtual care. To help practices avoid revenue leakage and claim denials, it’s critical to understand the new AMA 2025 Telemedicine Evaluation and Management (E/M) codes and how to use them correctly.

What’s New in 2025 Telemedicine E/M Codes?

The American Medical Association (AMA) introduced 17 new CPT® codes for telemedicine E/M services in 2025. These codes reflect the growing demand for both audio-video and audio-only care, ensuring providers can accurately document and report virtual encounters.

• CPT® 98000–98007: Synchronous audio-video visits (real-time video + audio).
• CPT® 98008–98015: Synchronous audio-only visits (real-time voice calls).
• CPT® 98016: Brief check-ins (5–10 min) for established patients only.

“Synchronous” means the patient and provider interact live, in real-time, as opposed to asynchronous (e.g., secure messaging or recorded videos).

Billing Guidelines and Key Code Selection Criteria

When billing for telemedicine, accurate code selection is based on medical decision-making (MDM) or total time spent with the patient.

1. MDM-Based Coding

• Requires a medically appropriate history and/or physical exam, just like in-person visits.
• MDM levels follow CPT®’s standard framework: straightforward, low, moderate, or high complexity.

2. Time-Based Coding

• Audio-video visits: Minimum 15 minutes for new patients, 10 minutes for established patients.
• Audio-only visits: Must include ≥10 minutes of medical discussion, regardless of MDM.
• Encounters under 5 minutes are not reportable unless using CPT® 98016.

Pro Tip: Time spent scheduling, setting up technology, or asynchronous messaging does not count toward total billable time.

Prolonged Telemedicine Services

For extended visits:

• New patients: Add CPT® 99417 if time ≥75 minutes.
• Established patients: Add CPT® 99417 if time ≥55 minutes.
• Report each additional 15-minute increment as prolonged service.

Key Documentation Requirements

To minimize audit risks and claim denials, telemedicine notes should clearly include:

• Patient consent to telehealth.
• Mode of telehealth (audio-video or audio-only).
• Start and end times (if time-based).
• Clinical details supporting MDM level.
• Location of patient and provider (required by some payers).

Special Scenarios and Billing Nuances

Technology failure (video-to-audio):
If a video call drops and continues by audio, bill based on where the majority of the interaction occurred. For audio-only, ensure ≥10 minutes of discussion.

Same-day in-person and telemedicine visits:
Bill the in-person E/M code only, ensuring no double-counting of MDM or time.

Modifiers and POS Codes for Telehealth

Many payers require modifiers and specific place-of-service (POS) codes for telehealth claims:

• Modifier 95: For synchronous telemedicine (commonly used).
• Modifier GT: Required by some commercial payers.
• POS 02: Telehealth provided outside the patient’s home.
• POS 10: Telehealth provided in the patient’s home (new CMS rule).

Always verify payer-specific rules—requirements vary by carrier and state.

The Impact of Accurate Telehealth Coding

Telehealth billing mistakes are costly.

• A 2024 MGMA study found that 72% of practices reported telehealth-related denials due to incorrect POS codes, missing consent documentation, or wrong code usage.
• Practices that implemented telehealth billing audits reduced denials by 20–30% and increased reimbursements significantly.

Client Case Study: Boosting Telehealth Revenue with Correct Code Usage

A mid-sized internal medicine practice in California faced high denial rates (18%) for telemedicine claims due to inconsistent coding for audio-only visits.

Solution:

• Implemented provider training on 2025 AMA codes.
• Automated telehealth documentation prompts in the EHR.
• Standardized use of POS 10 for home visits.

Result:

• Denial rate dropped to under 4%.
• $300,000 annual increase in telehealth reimbursements.

Best Practices for Telemedicine Billing in 2025

• Train staff regularly on AMA and payer telehealth guidelines.
• Use EHR automation to document time and MDM accurately.
• Conduct periodic billing audits to identify compliance gaps.
• Verify payer telehealth policies quarterly, as rules frequently change.
• Outsource billing to telehealth coding experts if in-house resources are limited.

The Future of Telemedicine E/M Codes

Telemedicine is expected to remain a significant part of healthcare delivery. McKinsey projects up to 20% of all outpatient visits will be virtual by 2026. The AMA’s 2025 E/M codes are an important step toward standardizing and accurately reimbursing telehealth care.

Final Takeaway

Understanding and applying the 2025 Telemedicine E/M codes correctly can dramatically reduce denials, improve compliance, and increase reimbursements. As telehealth regulations continue to evolve, staying proactive and informed is critical for financial stability.

Struggling to Keep Up with 2025 Telemedicine Coding Changes? Partner with Experts.

Telehealth regulations and billing requirements are evolving faster than ever, and even small coding errors can result in costly denials or compliance risks. Our team of certified medical coders and billing professionals stay fully updated on AMA guidelines, CMS regulations, and payer-specific telehealth policies, ensuring your practice gets accurate coding and maximum reimbursement every time.

Whether you need help with:

• Correct CPT® and modifier usage for telehealth encounters,
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• Claims denial management and revenue optimization, or
• End-to-end telehealth billing solutions,

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Partnering with us allows your team to focus on delivering exceptional patient care while we handle the complexities of coding and compliance behind the scenes.

Ready to eliminate coding headaches and improve your telehealth revenue? Contact us today to learn how our expert medical coding services can transform your practice’s financial health.