State & FederalAnthem Blue Cross and Blue Shield | Medicare AdvantageMarch 31, 2023

E-visits

Medicare Advantage allows coverage of online evaluation and management services for an established patient when all requirements have been met. The communication between patient and doctor is a cumulative of seven days and with at least the minimum of the minutes for the CPT® code being billed. Any services amounting to less than five minutes would not be appropriate to bill as an e-visit.

CPT code

Description

99421

Online digital evaluation and management service, for an established patient, for up to seven days, cumulative time during the seven days; 5 to 10 minutes

99422

Online digital evaluation and management service, for an established patient, for up to seven days, cumulative time during the seven days; 11 to 20 minutes

99423

Online digital evaluation and management service, for an established patient, for up to seven days, cumulative time during the seven days; 21 or more minutes

98970

Qualified nonphysician healthcare professional online digital assessment and management, for an established patient, for up to seven days, cumulative time during the seven days; 5 to 10 minutes

98971

Qualified nonphysician healthcare professional online digital assessment and management, for an established patient, for up to seven days, cumulative time during the seven days; 11 to 20 minutes

98972

Qualified nonphysician healthcare professional online digital assessment and management, for an established patient, for up to seven days, cumulative time during the seven days; 21 or more minutes

Here is a communication by CMS to help with further questions:

https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet.

MEAMH-CR-016638-23-CPN16365

PUBLICATIONS: April 2023 Provider News - Maine