Basics of CPT Code 98004, 98005, 98006, 98007
Since we are having new CPT codes for Established patient for Synchronous audio-video visit in 2025, we should be knowing the coding guidelines for these codes. Time is one the key factor to choose the correct code between CPT Code 98004, 98005, 98006, 98007. Below is the code description for these codes.
98004 Synchronous audio-video visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making.
When using total time on the date of the encounter for code selection, 10 minutes must be met or exceeded.
98005 Synchronous audio-video visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low medical decision making.
When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.
98006 Synchronous audio-video visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate medical decision making.
When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.
98007 Synchronous audio-video visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high medical decision making.
When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.
(For services 55 minutes or longer, use prolonged services code 99417)
How to choose the correct CPT Code 98004, 98005, 98006, 98007
Providers should report these codes for established patient visits conducted via telehealth, utilizing synchronous audio-video communication as an alternative to in-person consultations. During these encounters, both the provider and patient engage in real-time interaction, allowing them to see and hear each other from different locations. A medically appropriate history and/or examination is required for all visits.
Code selection is determined by either the level of medical decision making (MDM) or the total time spent by the physician or other qualified healthcare professional(s) on the day of the encounter. MDM factors to consider include the number and complexity of problems addressed, the volume and complexity of data reviewed, and the potential risks of complications, morbidity, or mortality associated with patient management.
CPT code 98004 represents the most basic service, involving straightforward MDM. If time is used for code selection, a minimum of 10 minutes must be met or exceeded. CPT code 98005 should be reported for visits requiring a low level of MDM or those meeting or exceeding 20 minutes of total time. CPT Code 98006 applies to visits requiring a moderate level of MDM or those that exceed 30 minutes. Finally, CPT code 98007 is used for visits involving a high level of MDM or those surpassing 40 minutes of total time.
For services 55 minutes or longer, use prolonged services code 99417
When to use CPT code 99417
99417 – Prolonged outpatient evaluation and management service(s) time with or without direct patient contact beyond the required time of the primary service when the primary service level has been selected using total time, each 15 minutes of total time (List separately in addition to the code of the outpatient Evaluation and Management service)
Prolonged time (with and without direct patient contact combined) that is provided by the physician or other qualified health care professional on the date of an evaluation and management service can be reported with CPT code 99417 for outpatient.
CPT code +99417 is an add-on code and should be used along with a primary code 98007.
Do not report 99417 for any time unit less than 15 minutes. Code 99417 would not be reported until at least 15 minutes of time beyond 55 minutes for CPT 98007 has been accumulated (70 minutes) on the day of the encounter.
