2025 CPT code 99421
(Active) Effective Date: N/A Evaluation and Management - Non-Face-to-Face Services Feed
Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes.
Modifiers may be applicable in certain situations, such as modifier 25 for a significant, separately identifiable E/M service on the same day.
Medical necessity for this code requires that the patient's problem necessitates the evaluation, assessment, and management of a physician or other qualified healthcare professional.
The physician or other qualified healthcare professional evaluates, assesses, and manages the patient's problem through online communication, including reviewing the inquiry, patient records, interacting with clinical staff, developing management plans, generating prescriptions or ordering tests, and communicating with the patient.
In simple words: A physician or other qualified healthcare professional discusses a health issue with an established patient using online communication technologies, offering potential treatment or management options. This code covers 5 to 10 minutes of total time spent with the patient over a period of up to 7 days.
This code represents an online digital evaluation and management service provided to an established patient over a 7-day period, with a cumulative service time of 5-10 minutes. The service is initiated by the patient through a HIPAA-compliant secure platform and includes the physician's review of the inquiry, review of patient records, interaction with clinical staff, development of management plans, and subsequent communication with the patient.
Example 1: An established patient with hypertension messages their physician through the patient portal with concerns about recent elevated blood pressure readings. The physician reviews the message, the patient's chart, and recent lab results. They then message the patient back with recommendations for adjusting their medication and lifestyle modifications. The total time spent by the physician is 7 minutes., An established patient messages their physician through the patient portal with a new complaint of a skin rash. The physician reviews the message and requests additional information and photos from the patient. After receiving the information, the physician provides a diagnosis and sends an electronic prescription for a topical cream. The total time spent by the physician is 8 minutes., An established patient messages their physician on day 1 with a question about medication side effects. The physician responds within 3 minutes. On day 3, the patient follows up with additional questions, which the physician addresses in 5 minutes. The total time spent by the physician over the 7-day period is 8 minutes.
Documentation should include the patient's inquiry, relevant patient history and data, the physician's assessment and plan, any prescriptions or orders, and a summary of communication with the patient. All documentation must be stored permanently, either electronically or in hard copy.
** This code is intended for established patients only. The patient must initiate the service.If the online inquiry is related to a surgical procedure and occurs during the postoperative period, this code is not reported separately.Virtual Communication: HCPCS Codes G2010, G2012, G2250, G2251, G2252.
- RVU: The approximate Medicare payment is $15.50 in a non-facility setting (as of 2020).
- Global Days: 7 days
- Payment Status: Active
- Specialties:This code can be used by various specialties, including primary care, internal medicine, and specialists who manage ongoing patient care through online communication.
- Place of Service:Office, telehealth provided other than in the patients home.