CPT 98012 Description, Billing Rules, & Use Cases
CPT 98012 is used to bill for a synchronous audio-only evaluation and management (E/M) service with an established patient that involves straightforward medical decision-making (MDM) or more than 10 minutes of total provider time on the date of the encounter.
Introduced in 2025 as part of the new audio-only telehealth E/M code set (98008–98015), this code replaced the deleted telephone E/M codes (99441–99443). CPT 98012 represents the lowest-complexity, established-patient level within the new series and is designed for brief but medically necessary telehealth visits that require real-time verbal communication without video.
The service typically includes:
- Review of patient status or minor acute complaints through audio-only communication
- Evaluation of stable or self-limited conditions
- Adjustment or continuation of medications under existing treatment plans
- Patient education, counseling, or self-care guidance
- Coordination of care or review of test results requiring minimal decision-making
- Documentation of total time and communication method (audio-only)
Billing Notes:
- Use for established-patient audio-only E/M visits requiring straightforward MDM or >10 minutes of total time.
- The provider must personally perform the service in real-time using audio-only technology.
- The visit cannot overlap with an in-person or audio-video E/M service on the same calendar day.
- Documentation must include patient consent, total time or MDM level, and that the encounter was conducted via audio-only communication.
- Encounters ≤10 minutes do not meet the threshold and may instead qualify as a brief communication technology service (CPT 98016).
What Is CPT Code 98012?
CPT 98012 is an evaluation and management (E/M) code for audio-only telemedicine visits with established patients that involve straightforward medical decision making (MDM) or more than 10 minutes of total provider time on the date of service.
Introduced in 2025, CPT 98012 is part of the new audio-only E/M series (98008–98015) created to replace the deleted telephone codes (99441–99443). It is used when a telehealth encounter—conducted entirely by phone or another synchronous audio technology—requires a focused medical discussion, simple problem solving, or limited data review.
Key points about CPT 98012:
- Used for established-patient audio-only visits requiring straightforward MDM or > 10 minutes of provider time.
- The encounter must include a medically appropriate history and/or exam, as determined by the provider.
- Communication must be real-time and synchronous (not asynchronous or message-based).
- Typical activities include reviewing stable conditions, adjusting medications, or providing self-care guidance.
- The visit must be personally performed by a qualified healthcare provider (physician, NP, PA, etc.).
- The service cannot occur on the same day as an in-person or audio-video E/M encounter.
In summary: CPT 98012 covers brief, low-complexity audio-only E/M visits for established patients that require more than 10 minutes of provider time and involve straightforward decision-making, follow-up care, or minor clinical management.
CPT 98012 Time Thresholds and Code Combinations
CPT 98012 represents a synchronous audio-only evaluation and management (E/M) service for an established patient that involves straightforward medical decision making (MDM) or more than 10 minutes of total provider time on the date of service.
Understanding the Time Component
When billing by time, the provider must personally spend more than 10 minutes performing and documenting the encounter on the same date.
Included time may involve:
- Reviewing recent notes, labs, or medication lists prior to or during the call
- Conducting a focused audio-only evaluation and addressing patient concerns
- Providing medication counseling or chronic care follow-up
- Coordinating care or confirming treatment adherence
- Documenting findings, decisions, and next steps in the patient record
If the total time is 10 minutes or less, the encounter cannot be reported as 98012 and may instead qualify for CPT 98016 (brief communication service).
Encounters involving more complex MDM or extended duration should be coded using higher-level established-patient audio-only codes (98013–98015).
Understanding the MDM Component
When selecting by MDM, documentation must demonstrate straightforward complexity, including:
- Evaluation of a single, stable condition or self-limited problem
- Minimal or low-risk management decisions
- Review of limited data (e.g., one lab or prescription refill)
- No immediate threat to patient safety or significant risk of complications
When to Use CPT 98012: Common Scenarios and Use Cases
CPT 98012 is appropriate when a physician, nurse practitioner (NP), or physician assistant (PA) provides a synchronous audio-only evaluation and management (E/M) visit with an established patient that involves straightforward medical decision making (MDM) or more than 10 minutes of total provider time on the same day.
Here are examples of how CPT 98012 is used in practice:
Medication Refill and Side Effect Check-In
A primary care provider conducts a follow-up call to:
- Review adherence and side effects for a stable hypertension medication
- Adjust dosing slightly based on patient feedback
- Reinforce diet and home blood pressure monitoring instructions
Total time: 14 minutes
Billing: 98012
Post-Acute Follow-Up for Resolved Infection
An NP follows up with a patient recently treated for a urinary tract infection to:
- Review lab results and confirm infection resolution
- Ensure medication completion and absence of recurrence symptoms
- Document findings and close the episode of care
Total time: 12 minutes
Billing: 98012
Ongoing Management of Stable Chronic Condition
A PA provides routine follow-up for a patient with well-controlled Type 2 diabetes to:
- Review glucose logs and confirm stability
- Discuss medication adherence and renewal
- Encourage ongoing diet and exercise adherence
Total time: 15 minutes
Billing: 98012
CPT 98012 Billing Requirements and Eligibility
CPT 98012 is used to report a synchronous audio-only evaluation and management (E/M) visit with an established patient that involves straightforward medical decision making (MDM) or more than 10 minutes of total provider time on the date of service.
This code represents the lowest-complexity level of established-patient audio-only E/M services introduced in 2025, replacing the lower tiers of the discontinued telephone codes (99441–99443).
Patient Eligibility
To qualify for CPT 98012:
- The patient must be established (seen by the same provider or group within the past three years).
- The encounter must be conducted via audio-only technology with real-time, two-way verbal communication.
- The patient must consent to receive care through an audio-only telehealth format.
- The condition(s) discussed must require straightforward MDM or more than 10 minutes of provider time.
- The service cannot occur on the same day as an in-person or audio-video telehealth encounter.
Provider Eligibility
The encounter must be personally performed by a physician, nurse practitioner (NP), or physician assistant (PA) qualified to report E/M services.
The provider must:
- Conduct the entire encounter personally via real-time audio communication.
- Document the total time or MDM level supporting the code selection.
- Record the modality (audio-only) and patient consent within the note.
- Provide a clinical assessment and plan consistent with E/M documentation standards.
Service Requirements
- Minimum provider time: More than 10 minutes on the date of service.
- Countable time includes reviewing the patient chart, conducting the discussion, documenting the visit, coordinating care, and any same-day follow-up communication.
- Non-countable time includes scheduling, administrative tasks, or unrelated calls outside the encounter.
- May be selected by MDM or total time, but documentation must clearly support the method used.
- Follow-up plans and patient instructions must be included in the record.
Documentation Requirements
The visit note must clearly include:
- Start and end time, or total provider time (>10 minutes).
- Patient consent for audio-only telehealth.
- Statement of modality (e.g., “audio-only telehealth encounter, no video used”).
- Reason for the encounter (chief complaint).
Straightforward MDM elements, including:
- Problems: A single stable, acute, or self-limited condition.
- Data: Minimal or limited review of prior notes, test results, or medication lists.
- Risk: Low risk of morbidity or complications.
- Clinical summary of discussion, findings, and next steps.
- Provider attestation confirming personal performance and accuracy.
- Non-duplication statement verifying no overlapping E/M services were billed on the same date.
Medicare and Payer Coverage Notes
- Medicare: CPT 98012 currently carries a status indicator “I” (invalid for Medicare billing).
- Commercial payers: May recognize CPT 98012 under the RBRVS system for reimbursement.
- Providers should verify payer-specific telehealth policies, as audio-only coverage may vary by state and insurer.
CPT 98012 Billing Documentation Checklist
To support compliant billing for CPT 98012, documentation must confirm that the encounter was a real-time, audio-only telehealth visit with an established patient, requiring straightforward medical decision making (MDM) or more than 10 minutes of total provider time.
Your encounter record should include:
- Patient consent for the use of audio-only telehealth, documented at the start of the encounter.
- Verification of patient identity using at least two identifiers (e.g., name and date of birth).
- Provider credentials and role (physician, NP, or PA) clearly listed.
- Statement of modality indicating “audio-only synchronous communication” (no video used).
- Chief complaint or reason for visit describing the issue addressed.
- Total provider time documented as >10 minutes, including:
- Exact start and end times, or
- Total duration on the date of service.
- Straightforward MDM documentation, showing:
- Problems: One stable chronic condition, minor acute issue, or preventive discussion.
- Data: Minimal review of notes, test results, or medication refills.
- Risk: Low risk of morbidity or treatment complications.
- Summary of clinical discussion, including:
- Patient-reported updates or concerns.
- Provider assessment, advice, or minor treatment adjustments.
- Self-care instructions or medication guidance.
- Provider attestation confirming personal performance and accuracy of the documentation.
- Non-overlap statement verifying that no other E/M (in-person or video) was billed on the same date.
- Follow-up plan documented, including next check-in or in-person visit schedule.
Common CPT 98012 Billing Mistakes (and How to Avoid Them)
❌ Billing Without More Than 10 Minutes of Documented Time
When coding by time, providers must clearly record more than 10 minutes of total provider time on the date of service. Encounters lasting 10 minutes or less do not qualify for 98012 and may instead meet criteria for CPT 98016 (brief communication technology service).
❌ Missing Straightforward MDM Justification
If selecting the code based on medical decision making, documentation must show straightforward complexity—a simple or stable problem, minimal data review, and low risk of treatment decisions.
❌ Failing to Specify Audio-Only Modality
Each encounter note must explicitly state that the visit was performed using audio-only synchronous communication (no video used). Payers may deny claims if this modality statement is missing.
❌ Omitting Patient Consent or Identity Verification
Patient consent for telehealth delivery and identity verification (e.g., name and date of birth) must be documented at the start of every encounter.
❌ Using CPT 98012 for New Patients
CPT 98012 applies only to established patients. New-patient audio-only visits must be billed under the 98008–98011 code range, based on time or MDM complexity.
❌ Counting Non-Billable Time
Administrative work, scheduling, or documentation performed outside the date of service cannot be included in total provider time. Only provider-performed, medically necessary tasks on the same date count toward the threshold.
❌ Reporting 98012 With Same-Day E/M Codes
Audio-only E/M codes (98008–98015) cannot be billed in conjunction with in-person or video-based E/M services for the same patient on the same day.
❌ Incomplete Clinical Summary
Even for brief encounters, providers must include a complete clinical narrative documenting the history, assessment, plan, and follow-up. Missing this summary can trigger payer denials or compliance reviews.
