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April 2025
Use new telemedicine codes, starting July 1, 2025
Blue Cross Blue Shield of Michigan and Blue Care Network commerical will require claims for virtual evaluation and management, or E/M, services to be submitted using new telemedicine procedure codes *98000 through *98015, effective July 1, 2025.
Continue to use the telemedicine place of service codes 02 or 10. The telemedicine modifiers aren’t required for the new telemedicine E/M procedure codes.
If rendering a virtual E/M service that’s audio-only or audio-video, don’t submit claims for these services using E/M procedure codes *99202 through *99205 or *99212 through *99215 with the telemedicine place of service codes or modifiers. The claims processing systems will be updated to deny these E/M codes when billed with any telemedicine place of service or modifiers as provider liable.
The reimbursement amounts for the telemedicine E/M procedure codes *98000 through *98015 and the other outpatient visit E/M procedure codes *99202 through *99205 and *99212 through *99215 are available in the provider portal.
Telemedicine synchronous audio-video codes
New telemedicine E/M codes, effective July 1, 2025 |
Do not use these codes for telemedicine services |
Code |
Description |
Code |
Description |
*98000 |
Synchronous audio-video visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded. |
*99202 |
Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded. |
*98001 |
Synchronous audio-video visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded. |
*99203 |
Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded. |
*98002 |
Synchronous audio-video visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded. |
*99204 |
Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded. |
*98003 |
Synchronous audio-video visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded. |
*99205 |
Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded. |
*98004 |
Synchronous audio-video visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 10 minutes must be met or exceeded. |
*99212 |
Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 10 minutes must be met or exceeded. |
*98005 |
Synchronous audio-video visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded. |
*99213 |
Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded. |
*98006 |
Synchronous audio-video visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded. |
*99214 |
Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded. |
*98007 |
Synchronous audio-video visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded. |
*99215 |
Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded. |
Telemedicine synchronous audio-only codes
New telemedicine E/M codes, effective July 1, 2025 |
Do not use these codes for telemedicine services |
Code |
Description |
Code |
Description |
*98008 |
Synchronous audio-only visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination, straightforward medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded. |
*99202 |
Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 15 minutes must be met or exceeded. |
*98009 |
Synchronous audio-only visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination, low medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded. |
*99203 |
Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded. |
*98010 |
Synchronous audio-only visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination, moderate medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded. |
*99204 |
Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded. |
*98011 |
Synchronous audio-only visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination, high medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded. |
*99205 |
Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded. |
*98012 |
Synchronous audio-only visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination, straightforward medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 10 minutes must be exceeded. |
*99212 |
Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 10 minutes must be met or exceeded. |
*98013 |
Synchronous audio-only visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination, low medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded. |
*99213 |
Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded. |
*98014 |
Synchronous audio-only visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination, moderate medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded. |
*99214 |
Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded. |
*98015 |
Synchronous audio-only visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination, high medical decision making, and more than 10 minutes of medical discussion. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded. |
*99215 |
Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded. |
Frequently asked questions
Question: Will claims be denied if non-virtual E/M codes are billed using telemedicine place of service codes and modifiers?
Answer: Effective July 1, 2025, Blue Cross and BCN claims processing systems will be updated to reject the non-virtual E/M codes when billed with the telemedicine place of service and modifiers as provider-liable.
Q: Will Blue Cross limit virtual services to the use of the new telemedicine E/M procedure codes only?
A: No. There are other procedure codes that identify telemedicine services that aren’t for an E/M visit. These services are still allowed. For example, Asynchronous/Store and Forward procedure codes.
Q: What about the other procedure codes that are billed for telemedicine services that aren’t for an E/M procedure code?
A: This telemedicine update only applies to E/M procedure codes. According to the American Medical Association coding guidelines, these codes are specific to E/M visits that are rendered synchronous (real time) through audio-video and audio-only.
Q: Have prior provider communications for these new codes been released?
A: Yes. We introduced the new telemedicine procedure codes as payable, effective Jan. 1, 2025, in the 2025 CPT and HCPCS Update document, which we communicated about in the February 2025 Record. Additional communications will be posted in our provider portal, Availity Essentials™, and The Record.
Q: What is the difference in the reimbursement of the current E/M procedure codes and the new telemedicine E/M procedure codes for the Centers for Medicare & Medicaid Services?
A: Currently, CMS doesn’t allow for the reimbursement of the new telemedicine E/M procedure codes. The reimbursement amounts for the new telemedicine procedure codes for Blue Cross and BCN are available in the provider portal.
Q: Will Blue Cross reimburse both the new telemedicine E/M procedure codes and the office and outpatient E/M procedure codes?
A: Yes. Blue Cross and BCN will continue to reimburse both the office and outpatient, and telemedicine E/M procedure codes. However, effective July 1, 2025, Blue Cross and BCN will only reimburse virtual E/M services using the new telemedicine E/M codes. If a virtual service is reported with the office and outpatient codes *99202 through *99205 or *99212 through *99215, the claim will reject and a resubmission will be required.
Q: Will the new telemedicine E/M codes requirement align with current Blue Cross and BCN Telemedicine Services Medical Policy?
A: Yes. The Telemedicine Services Medical Policy lists the medical criteria for a virtual visit along with the inclusion and exclusion guidelines for telemedicine services.
Q. What is the HMO authorization requirement for telemedicine services for BCN?
A: The authorization requirement for E/M services is referral. A referral will be required when an E/M service is not provided by the primary care provider.
Q: Does Blue Cross and BCN cover procedure code *98016?
A: Yes. Procedure code *98016 is payable.
None of the information included in this article is intended to be legal advice and, as such, it remains the provider’s responsibility to ensure that all coding and documentation are done in accordance with all applicable state and federal laws and regulations.
Availity® is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to offer provider portal and electronic data interchange services. |
