State & FederalMedicare AdvantageMarch 31, 2023

E-visits

Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem.

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

NYBCBS-CR-016641-23-CPN16365

PUBLICATIONS: April 2023 Provider News - New York