2025 CPT code 99422
(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; 11-20 minutes
Yes, modifiers may be applicable to clarify the service provided.
Medical necessity for this code requires that the online digital E/M service be for the purpose of evaluation, assessment, and management of a patient's medical condition. It should not be used for simple communication such as appointment scheduling or test result delivery without medical discussion.
The physician or other qualified healthcare professional communicates with the patient online to address a health issue for an established patient. This involves responding to patient concerns, answering medical questions, and recommending management.The encounter is documented in the patient's record, and follow-up may occur via telephone or email.
In simple words: A physician or other qualified healthcare professional discusses a health issue and possible treatment or management with an established patient using online communication technologies. This code covers 11 to 20 minutes of cumulative time spent with the patient for a period of up to 7 days.
This code represents an online digital evaluation and management service provided to an established patient over a period of up to 7 days, with a cumulative time of 11-20 minutes spent by the physician or other qualified healthcare professional during those 7 days.
Example 1: An established patient sends a secure message through the patient portal inquiring about a new rash they developed two days prior. The physician reviews the message, the patient's history, and requests additional photos. Over the next three days, the physician exchanges secure messages with the patient, totaling 15 minutes, and prescribes a topical cream electronically. This encounter would be coded as 99422., An established patient with hypertension sends a secure message requesting a refill on their blood pressure medication. The physician reviews the message, accesses the patient's recent lab results and blood pressure readings, and electronically renews the prescription. The total time spent is 12 minutes over two days, and the encounter would be coded as 99422., A patient emails their physician on Monday with worsening back pain. The physician requests the patient to complete a pain questionnaire via a secure digital application. The physician reviews the patient's response the following day and creates a plan of care, including exercises and physical therapy referral, and communicates this to the patient on Wednesday. The physician continues to respond to the patient’s questions over the next few days. The total time spent coordinating care over a 5-day period is 17 minutes. This would be coded as 99422.
Documentation should include the date and time of each online communication, a summary of the patient's inquiry, the physician's review and assessment, any orders or prescriptions generated, and the total cumulative time spent on the service during the 7-day period.
- Specialties:This code can be used by various medical specialties, including primary care, specialists, and other qualified healthcare professionals, provided they meet the requirements outlined in the CPT code description.
- Place of Service:Office, Home, Telehealth Provided in Patient’s Home, Telehealth Provided Other than in Patient’s Home and other places of service applicable to this code.