In-Person & Telehealth E/M Visit Codes (CPT 99202–99215)
Clinii’s Evaluation & Management (E/M) tools help providers accurately document visit complexity, select the correct CPT code by time or MDM, and streamline billing for in-person and telehealth encounters—all while ensuring compliance and maximizing reimbursement.
What Are In-Person & Telehealth E/M Codes?
Evaluation & Management (E/M) codes 99202–99215 represent the most common outpatient visit types used across primary and specialty care. These codes describe provider-patient encounters—whether in person or via real-time telehealth video—based on the medical decision making (MDM) involved or the total time spent delivering care.
In 2025, E/M documentation standards remain centered on two key elements:
- Medical Decision Making (MDM): The complexity of clinical reasoning, data review, and risk of morbidity or mortality.
- Time-Based Coding: The total provider time spent on the date of service performing relevant care activities, such as reviewing data, counseling, documenting, and coordinating care.
The 99202–99215 range applies to outpatient or office visits and is divided into two categories:
These codes are the cornerstone of clinical billing and drive accurate documentation, compliance, and value-based reporting.
Primary Aims of E/M Coding
Ensure Accurate Code Selection
E/M coding allows providers to select visit levels that truly reflect clinical effort. The structured framework of time or MDM ensures every visit—simple or complex—is properly classified and billed according to current AMA guidelines.
Simplify Documentation Requirements
Updated rules have removed unnecessary history and exam mandates, letting providers focus on what matters most: decision making, coordination, and care quality. Clear MDM criteria now define complexity in a measurable, auditable way.
Support Telehealth Reimbursement
E/M codes apply equally to in-person and telehealth video encounters, ensuring continuity of billing for hybrid or virtual care models. This parity enables providers to maintain compliance while expanding access to remote visits.
Reduce Claim Denials and Audits
Using the correct E/M level helps eliminate downcoding and payer disputes. Proper documentation of MDM elements or total time protects providers from denials and supports audit defense under both Medicare and commercial payers.
Promote Consistency Across Teams
Capture Prolonged Care Time
When visits extend beyond typical durations, the add-on code CPT 99417 allows providers to report additional time. This ensures compensation for extended care coordination, counseling, or complex medical decision making.
New Patient E/M Codes
CPT 99202
Straightforward MDM or 15–29 minutes of total time. Used for low-complexity new patient visits involving minimal data review and low risk of complications.
CPT 99202CPT 99203
Low-complexity MDM or 30–44 minutes of total time. Applies to new patient encounters requiring limited data analysis and low-risk management decisions.
CPT 99203CPT 99204
Moderate MDM or 45–59 minutes of total time. Appropriate when multiple conditions are reviewed, moderate risk is present, or care coordination is required.
CPT 99204CPT 99205
High-complexity MDM or 60–74 minutes of total time. Used for extensive evaluations involving comprehensive data review and high-risk decision making.
CPT 99205Established Patient E/M Codes
CPT 99211
Used for minimal or no MDM and typically under 10 minutes of total time. Applies when clinical staff perform a brief, medically necessary service under provider supervision—such as recording vitals or reviewing a simple concern.
CPT 99211CPT 99212
Straightforward MDM or 10–19 minutes of total time. Suitable for brief, low-complexity follow-up visits addressing minor or self-limited conditions.
CPT 99212CPT 99213
Low-complexity MDM or 20–29 minutes of total time. Typically used for stable conditions requiring limited decision making and minimal data review.
CPT 99213CPT 99214
Moderate MDM or 30–39 minutes of total time. Applies to ongoing management of chronic or multi-system conditions requiring moderate risk and decision complexity.
CPT 99214CPT 99215
High-complexity MDM or 40–54 minutes of total time. Used for complex follow-up or management visits involving high risk of morbidity and extensive coordination of care.
CPT 99215Add-On Prolonged Service Code
CPT 99417
Used for each additional 15 minutes beyond 99205 (new patient) or 99215 (established patient). Captures prolonged provider time spent on counseling, documentation, or complex care management.
CPT 99417Key Benefits
Streamlined care coordination
Reduced hospital readmissions
Medicare reimbursement
Improved operational efficiency
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integration Frequently Asked Questions About E/M Visit Coding
How do providers choose between MDM and time for code selection?
Providers can select either medical decision making (MDM) or total time on the date of service. The method that yields the higher appropriate code can be used, but documentation must support that choice. MDM-based coding requires detailed reasoning around problem complexity, data reviewed, and risk.
Can prolonged services (99417) be billed with telehealth visits?
Yes. CPT 99417 can be reported with 99205 or 99215 for in-person or telehealth video encounters when provider time exceeds the threshold by 15 minutes or more. Documentation must clearly specify total time and list activities performed beyond the base E/M visit.
Do E/M codes apply to audio-only visits?
No. Audio-only visits are billed under CPT 98008–98016, introduced in 2025. E/M codes 99202–99215 are reserved for in-person or audiovisual telehealth encounters where the provider and patient can see and hear one another in real time.
How does telehealth E/M coding differ from in-person visits?
Telehealth E/M visits use the same CPT codes and levels, but documentation must include modality (audio-video) and patient consent for virtual care. Otherwise, all standard MDM and time rules apply identically.
Are in-person and telehealth visits reimbursed at the same rate?
In most cases, yes. CMS and many commercial payers maintain payment parity for telehealth E/M visits when criteria are met, though parity may vary by state and insurer. Providers should confirm payer policies for telehealth reimbursement each plan year.
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