2025 CPT Code Updates: What Your Practice Needs to Know

The 2025 CPT code update brings substantial changes, particularly for telehealth services. Understanding these updates is critical for accurate billing and maximum reimbursement.

17 New Telehealth-Specific Codes

The American Medical Association (AMA) has introduced a new series of telehealth codes for 2025:

Audio-Video Telemedicine Codes (98000-98007)

These codes are for synchronous audio-video visits with patients:

• 98000-98003: New patient audio-video visits based on medical decision-making complexity
• 98004-98007: Established patient audio-video visits based on medical decision-making complexity

Audio-Only Telemedicine Codes (98008-98015)

For practices offering telephone consultations:

• 98008-98011: New patient audio-only visits
• 98012-98015: Established patient audio-only visits

Important Medicare Consideration

Here’s a critical point that billing teams must understand: Medicare has NOT adopted the new 98000-98015 codes. For Medicare claims, practices should continue using:

• Standard E/M codes 99202-99215 with modifier 95 for audio-video visits
• Standard E/M codes 99202-99215 with modifier 93 for audio-only visits

Virtual Check-In Code Update

The new code 98016 replaces G2012 for brief virtual check-ins (5-10 minutes) with established patients. This code IS covered by Medicare.

Implementation Steps for Your Practice

• Update your EHR templates to capture required documentation elements
• Train coding staff on when to use new codes vs. traditional E/M codes
• Verify each payer’s policy on the new telehealth codes
• Update encounter forms and superbills
• Implement a tracking system for the first quarter to catch any coding errors

Documentation Requirements

Regardless of which codes you use, documentation for telehealth visits should include:

• Total encounter time (required for time-based billing)
• Modality used (audio-video vs. audio-only)
• For audio-only: documentation that provider has video capability but patient preferred or was unable to use video
• Location of both originating site (patient) and distant site (provider)
• Patient verbal consent documented in the medical record

Getting Help with Implementation

The 2025 code changes require careful planning and payer verification. Our team at ProCareMedEx can help ensure your practice implements these changes correctly and maximizes reimbursement. Contact us for a complimentary review of your telehealth billing processes.

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