Evaluation & Management (E/M) and Audio-Only Visit Codes for Providers

Evaluation & Management (E/M) services describe how providers assess, diagnose, and manage patient conditions during an encounter. They’re billed using CPT codes 99202–99215, which are chosen based on medical decision making (MDM) or total time spent. These codes apply to both in-person and telehealth visits and serve as the foundation for outpatient care documentation and reimbursement.

For 2025, the AMA introduced a new family of audio-only E/M codes (98008–98016), replacing older telephone service codes. These allow providers to bill for real-time, audio-only communications that meet specific duration and complexity criteria. The update standardizes documentation rules across in-person, video, and audio-only visits, improving consistency and compliance.

CPT 99417 is an add-on code used when a provider spends 15 minutes or more beyond the time threshold of a standard E/M visit. It can be reported for both new and established patient visits (99205, 99215) when documentation supports the additional time. This ensures providers are reimbursed fairly for extended care coordination, patient counseling, and complex discussions that exceed standard encounter durations.

In-person and video-based E/M visits (99202–99215) include physical or visual assessments, while audio-only codes (98008–98015) apply to real-time verbal communication without video. Both are structured around MDM and time, but audio-only codes require documentation of modality (audio-only) and patient consent, confirming the patient opted for a voice-only encounter.

No. E/M codes are defined by patient type:

• New patients: 99202–99205 (in-person/video) or 98008–98011 (audio-only)
• Established patients: 99212–99215 (in-person/video) or 98012–98016 (audio-only)
  A patient is considered established if seen by the same provider or group within the past three years. Using the wrong patient type can trigger payer denials or claim rejections.

No. CPT 98016 is limited to established patients and represents a brief, 5–10 minute, patient-initiated audio-only communication—similar to the discontinued HCPCS code G2012. If a new patient initiates contact, the provider must use a full E/M code (98008–98011) or handle the interaction as non-billable triage.

Currently, audio-only codes (98008–98016) carry a status indicator “I” (invalid for Medicare billing) pending CMS policy adoption. However, many commercial and state-based payers are expected to recognize these codes for reimbursement in 2025. Providers should verify payer-specific telehealth policies before billing.

Clinii automates E/M coding and billing across all modalities. The platform integrates time tracking, MDM prompts, and telehealth consent fields directly into documentation workflows. Providers can record encounters, generate CPT codes automatically, and export compliant claims—all from one EHR-connected dashboard.

Generally, only one E/M service per provider, per patient, per day is billable. Exceptions apply if two distinct and separately identifiable services occur (e.g., a preventive visit plus a problem-oriented visit), each documented fully with separate notes and modifiers (e.g., Modifier 25). However, audio-only and in-person visits on the same day are rarely payable together.

For time-based coding, documentation must include the total provider time spent on the date of service—covering chart review, patient communication, and same-day documentation. Use clear phrasing such as:

“Total provider time on the date of service: 32 minutes, including record review, patient counseling, and care planning.”
Providers should not count time for administrative or post-encounter tasks performed on later dates.