New entries pertaining to digital medicine that were incorporated into the AMA Current Procedural Terminology (CPT®) code set for 2025 do not require the traditional telemedicine modifiers that typically have been used to signify that the services have been delivered remotely.
“The reason for that is that telemedicine is inherent in these codes,” Leslie Prellwitz, the AMA’s director of CPT development, said during an AMA webinar on how to use the new digital medicine codes. “It does not require a modifier in order for telemedicine to occur—they were built that way.”
A new AMA resource, “Digital Medicine Clinical Scenarios: Coding Handbook” (PDF), outlines CPT coding guidance for 14 common digital medicine encounters and explains place-of-service codes and modifiers. The AMA handbook also clarifies how recent changes, such as the introduction this year of telemedicine-specific CPT codes, affect reporting practices.
The scenarios covered include synchronous audio-video visits for new or established patients, online evaluation and management, self-measured BP, ambulatory continuous glucose monitoring and chronic care management.
“Given that many of these codes are new and there are several questions about how to use them appropriately, the AMA, with support from Manatt Health, developed this handbook to detail common clinical encounters and an overview of appropriate CPT guidance for each,” the handbook’s introduction says.
Also discussed in the handbook and during the webinar were digital medicine codes for remote physiological monitoring and self-measured BP readings taken by patients outside of the clinical setting and are automatically transmitted to their physician or care team.
There are three main codes used in the clinical scenarios for remote physiological monitoring:
- 99453: For set up and calibration of remote-monitoring devices such as a weight scale or glucometer and educating patients on how to use them.
- 99454: For initial supplying of the devices and 30 days of remote monitoring of the data they transmit.
- 99457: For treatment management services, to use the results of the monitoring to manage a patient under a specific treatment plan.
Prellwitz also noted that, to meet CPT reporting requirements, devices need to meet the Food and Drug Administration’s definition of a medical device and that the remote service needs to be ordered by a physician or other qualified health care professional.
The handbook includes a discussion of Appendix R, the place in the code set where codes describing remote therapeutic-monitoring services are housed. These include codes for digital cognitive behavioral therapies and codes representing the review and monitoring of data related to the patient’s response to musculoskeletal and respiratory system therapies.
“Things to remember is that those codes have been created for different service components: education, supply and monitoring treatment plans,” Prellwitz said. “The key with really using them is to make sure that you match the codes you report with the services you provided at that particular time.”
Also discussed was the use of CPT code 98016, for brief, technology-based services by a physician or other qualified health professional who can report E/M services.
Prellwitz said this code is designed to describe patient-initiated communication of five to 10 minutes in length and video technology is not required.
The webinar provided a discussion of three of the 14 scenarios contained in the handbook.
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Payer variation anticipated
The Centers for Medicare & Medicaid Services (CMS) is insisting that the telemedicine-coding modifiers continue to be used.
“CMS has decided to take a slightly different path in terms of how they would like telemedicine visits reported for their constituencies,” Prellwitz said.
“While we have new codes that do not require modifiers, they are currently recommending for Medicare reporting that you report what I'll term the original outpatient visit codes with an appropriate modifier, either 95 for audiovisual or 93 for audio only,” she explained. “That is going to be a variance from CPT-recording guidelines.”
“It is important for physicians to connect with their payers to confirm their specific reporting standards for these codes,” the handbook says. Given the reporting variances, Prellwitz said “we would expect that there might be some higher levels of variation in how commercial payers accept and use those codes in their reporting guidelines.”
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