What Is CPT Code 98000?
CPT code 98000 covers a synchronous audio-video telemedicine visit with a new patient requiring straightforward medical decision making, or 15 to 29 minutes of total time on the encounter date. The American Medical Association introduced the code effective January 1, 2025.
The code sits in the CPT book, and traditional Medicare won’t pay it. That one fact decides whether your claim clears or bounces. Commercial plans and several state Medicaid programs take a different position, so the payer on the card drives the decision.
The coding team behind ClaimMax RCM medical billing maintains this guide against current CPT descriptors and the CY 2026 Medicare Physician Fee Schedule, and updates it whenever CMS publishes new telehealth rulemaking.
The full 98000 CPT code description sits in the AMA CPT codebook under Telemedicine Evaluation and Management Services. The specification below condenses it into the fields a biller checks before submission.
CPT 98000 at a glance
| Attribute | Value |
|---|---|
| Patient Type | New patient |
| Technology | Synchronous audio-video communication |
| Medical Decision Making (MDM) | Straightforward |
| Time Requirement | 15 minutes met or exceeded (typically 15 to 29 minutes) |
| Code Family | Telemedicine Evaluation and Management Services |
| Effective Date | January 1, 2025 |
| Maintained By | American Medical Association |
| Medicare Status | Status indicator I, not valid for Medicare purposes |
| Office Visit Equivalent | CPT 99202 |
Table 1. CPT 98000 specification summary. Source: AMA CPT code set, CY 2026 Medicare Physician Fee Schedule.
Where CPT 98000 Sits in the 98000 to 98016 Telehealth Code Family
98000 opens the AMA’s telemedicine evaluation and management section, which arrived with the 2025 CPT code set and carries into 2026 unchanged. The section splits by modality and by patient status, and the table below shows where each range lands.
Telephone codes 99441, 99442, and 99443 left the code set on January 1, 2025. HCPCS G2012 went with them, replaced by 98016. A 2026 claim carrying any of those four codes denies before it reaches an adjudicator.
The three subgroups explained
| Range | Modality | Patient types | Selection basis |
|---|---|---|---|
| 98000 to 98007 | Synchronous audio-video | New: 98000 to 98003. Established: 98004 to 98007. | MDM or total time |
| 98008 to 98015 | Synchronous audio-only | New: 98008 to 98011. Established: 98012 to 98015. | MDM or total time, plus more than 10 minutes of medical discussion |
| 98016 | Brief communication technology service | Established only | 5 to 10 minutes, patient-initiated |
Table 2. The 98000 to 98016 telehealth CPT codes 2026 family structure. Source: AMA CPT code set.
One correction worth making before you build these into a charge master. The established patient audio-video range runs 98004 to 98007. Published references sometimes stop at 98006, which drops a code your commercial payers may accept.
| Watch the 10-minute ruleThe requirement for more than 10 minutes of medical discussion belongs to the audio-only range, 98008 through 98015. It does not apply to 98000. Several published guides attach it to the audio-video codes, and that error will cost you a level of service on review. |
The AMA published its own explanation of why the panel built these new telehealth codes for 2025. See the AMA telehealth CPT guidance for the panel rationale.
Time and MDM Requirements for CPT Code 98000
Pick 98000 on medical decision making or on total time, and never on both. Straightforward MDM supports the code on its own. Coding by time instead, you need 15 minutes, and the practical ceiling sits at 29 minutes because 30 minutes moves the visit to 98001.
The CPT 98000 description publishes a floor and stops there. Each ceiling in the table below comes from the next code’s floor. A 30-minute new patient video visit belongs to 98001, so 98000 tops out one minute earlier.
The complete time ladder for 98000 to 98007
| CPT code | Patient | MDM level | AMA threshold | Practical range |
|---|---|---|---|---|
| 98000 | New | Straightforward | 15 minutes met or exceeded | 15 to 29 minutes |
| 98001 | New | Low | 30 minutes | 30 to 44 minutes |
| 98002 | New | Moderate | 45 minutes | 45 to 59 minutes |
| 98003 | New | High | 60 minutes | 60 to 74 minutes |
| 98004 | Established | Straightforward | 10 minutes | 10 to 19 minutes |
| 98005 | Established | Low | 20 minutes | 20 to 29 minutes |
| 98006 | Established | Moderate | 30 minutes | 30 to 39 minutes |
| 98007 | Established | High | 40 minutes | 40 to 54 minutes |
Table 3. Audio-video telemedicine time ladder. AMA thresholds are published floors. Practical ranges close at the next code threshold. Source: AMA CPT E/M guidelines.
At 75 minutes or more, report CPT 99417 prolonged services with 98003. At 55 minutes or more, report 99417 with 98007. 99417 never pairs with 98000, because the base threshold sits too low to leave a complete prolonged unit.
What time you can and cannot count
Count the minutes the physician or qualified health care professional personally spent on the encounter date. Reviewing outside records, ordering medications or tests, documenting in the chart, and coordinating care all count toward the total.
Leave out the scheduling call and the minutes spent establishing the connection on your telehealth platform. Time already billed under another CPT code stays out too. Those exclusions cost practices a level of service on audit more often than any other time error.
When another E/M service by the same specialty lands on the same date, combine the elements or the time and report one service rather than two.
CPT 98000 vs 99202: The Crosswalk Most Billing Teams Get Wrong
98000 and 99202 describe the same clinical encounter. New patient, straightforward medical decision making, comparable time on the date of service. Modality separates them, and so does the payer.
Both codes carry a work RVU of 0.93, so CMS values the physician effort at the same level. The practice expense component is where the payment splits, and those dollar figures appear in the reimbursement section below.
Full crosswalk: 98000 to 98007 and their office visit equivalents
| Telehealth code | Office visit equivalent | Patient | MDM |
|---|---|---|---|
| 98000 | 99202 | New | Straightforward |
| 98001 | 99203 | New | Low |
| 98002 | 99204 | New | Moderate |
| 98003 | 99205 | New | High |
| 98004 | 99212 | Established | Straightforward |
| 98005 | 99213 | Established | Low |
| 98006 | 99214 | Established | Moderate |
| 98007 | 99215 | Established | High |
Table 4. Telemedicine to office visit crosswalk by patient status and MDM level. These are clinical equivalents, not payment equivalents and not payer-mandated substitutions. Source: AMA CPT code set.
For the documentation standard sitting under the new patient equivalent, see the ClaimMax CPT 99202 billing guide. The established patient tier runs through the 99212 decision guide.
When the two codes are not interchangeable
Three conditions break the equivalence, and each one shows up on remittances.
- Medicare pays 99202 and denies 98000, so the crosswalk reverses direction depending on the payer.
- 99202 carries no telehealth language in its descriptor, so a modifier and a place of service code have to signal the modality.
- A commercial payer that accepts both codes can still price them at two different rates under one contract.
Does Medicare Pay CPT Code 98000?
No. Traditional Medicare doesn’t pay 98000. CMS assigned 98000 through 98015 a fee schedule status indicator of I, meaning not valid for Medicare purposes. Submit the code to Medicare fee-for-service and the claim denies. 98016 is the one exception CMS reimburses.
CMS confirmed the position for 2026. A request came in to add the telemedicine E/M codes to the Medicare Telehealth Services List, and the agency declined in the CY 2026 Physician Fee Schedule final rule, CMS-1832-F. Status indicator I carried forward unchanged.
What to bill Medicare instead
Medicare telehealth CPT codes run on the office visit series instead. Medicare identifies a telehealth encounter through the place of service code and the modifier, not through a telehealth-specific CPT code. That single design choice is what forces two billing pathways inside one practice.
| Encounter type | Bill to Medicare | POS | Modifier |
|---|---|---|---|
| Audio-video E/M | 99202 to 99215 | 10 or 02 | None required |
| Audio-only E/M | 99202 to 99215 | 10 or 02 | 93 (FQ for FQHC and RHC) |
| Brief virtual check-in | 98016 | 10 or 02 | None |
| Online digital E/M (e-visit) | 99421 to 99423 | Standard POS | None |
Table 5. Medicare substitution pathway for telehealth encounters. Source: CMS CY 2026 Physician Fee Schedule, AAFP telehealth coding guidance.
Running two pathways inside one billing system is where most practices lose the thread. The ClaimMax medical billing service team builds the payer routing rules and the scrubber edits so the Medicare claim and the commercial claim never cross wires. For the mid-tier documentation standard, see the 99204 documentation rules.
Why CMS made this decision
CMS determined the telemedicine E/M codes duplicate existing office visit codes reported with a telehealth modifier and the right place of service. The agency found no programmatic need to recognize a second code set describing the same work.
You can verify the current position against the Medicare Telehealth Services List and the policy summary in CMS MLN Matters MM14315.
Which Payers Accept CPT 98000 in 2026
Commercial plans and several state Medicaid programs accept the 98000 series. Medicare doesn’t. That split gives you two billing pathways for one clinical encounter, and routing a claim down the wrong one is the fastest route to a denial.
Commercial payer adoption
Adoption follows the contract, not the carrier logo. The same national payer can accept 98000 on one product and require 99202 with modifier 95 on another. Confirm at the plan level rather than the carrier level, in writing, before the visit.
Coverage confirmation belongs in the pre-service workflow. ClaimMax insurance eligibility verification checks plan-level telehealth policy 48 to 72 hours ahead of the appointment, which catches a code-set mismatch while the schedule can still absorb it.
State Medicaid adoption
Wisconsin ForwardHealth covers the telehealth CPT codes 98000 through 98015 for evaluation and management services. Virginia Medicaid includes 98000 in its telehealth services supplement. Two state programs tell you nothing about the other 48, so pull your own state fee schedule and telehealth supplement.
| Payer type | Accepts 98000? | Bill instead | Verification step |
|---|---|---|---|
| Medicare fee-for-service | No | 99202 to 99215 with POS | None needed, the rule is fixed |
| Medicare Advantage | Varies by plan | Confirm per plan | Provider manual, in writing |
| Commercial | Often, varies by contract | 99202 to 99215 with modifier 95 where the series is not accepted | Plan-level policy, not carrier-level |
| State Medicaid | Varies by state | Per state manual | State fee schedule and telehealth supplement |
Table 6. Payer pathway by plan type. Commercial and Medicaid positions vary by contract and by state. Source: CMS, state Medicaid telehealth supplements.
The ACAAI telemedicine code guidance documents the full descriptor set alongside the CMS payment position, which makes it a useful cross-check when a payer rep gives you a different answer than the contract does.
Does CPT Code 98000 Need Modifier 95?
No. Modifier 95 doesn’t belong on 98000, because the descriptor already states the service ran on synchronous audio and video. Appending 95 repeats information the code already carries.
A small number of payers ask for 95 on the 98000 series anyway, for internal tracking. Adding it where the payer doesn’t want it can trip a clearinghouse edit and hold the line. Check the plan policy before you build the rule into your scrubber.
The full telehealth modifier matrix
| Modifier | Meaning | Use with | Do not use with |
|---|---|---|---|
| 95 | Synchronous audio-video | 99202 to 99215 for commercial telehealth | 98000 to 98007, Medicare audio-video |
| 93 | Synchronous audio-only | 99202 to 99215 for Medicare audio-only | 98008 to 98015 |
| FQ | Audio-only, FQHC and RHC | Same meaning as 93 in those settings | Non-FQHC and non-RHC claims |
| GT | Legacy audio-video | Critical Access Hospital Method II institutional claims | Professional Medicare claims, or alongside 95 |
| BB, BC | Proposed telehealth platform identifiers | Not yet in effect for 2026 | Any current claim |
Table 7. Telehealth modifier assignment for 2026. Source: AMA CPT Appendix P, CMS claims processing guidance, AAFP.
Modifiers that no longer apply
GT left Medicare Part B in 2018 and survives on Critical Access Hospital Method II institutional claims. Pairing GT with 95 on one service line gets the line rejected at most clearinghouses. FQ covers audio-only claims from FQHCs and RHCs, carrying the same meaning as 93.
The place of service side of this decision runs on separate rules. The ClaimMax POS 02 telehealth guide walks through the documentation each POS code requires. For the Medicare position on modifier requirements, the AAFP telehealth coding guidance states the Medicare position without hedging.
POS 10 vs POS 02: The Place of Service Decision That Changes Your Payment
POS tells the payer where the patient sat, not where the provider sat. POS 10 means the patient connected from home and prices at the non-facility rate. POS 02 covers every other patient location and prices at the lower facility rate.
Most practices default every telehealth claim to POS 02, a habit carried over from 2020. Most telehealth patients are at home. That default underprices the majority of a telehealth panel, and no line on the remittance flags it for you.
How to pick the right POS every time
Confirm the patient location at the start of the encounter, document it in the note, and match the POS to what the note says. Three steps, and the first one carries the other two.
Auditors read the utilization pattern alongside the individual claim. A practice showing POS 02 on 100% of telehealth claims implies no patient ever connected from home, and that pattern draws a post-payment review on its own.
| POS | Patient location | Rate applied | Common error |
|---|---|---|---|
| 10 | Home or private residence | Non-facility, the higher rate | Coded as 02 out of habit |
| 02 | Clinic, SNF, hospital, any non-home site | Facility, the lower rate | Applied to every telehealth claim by default |
| 11 | Office, in-person only | Non-facility | Used for telehealth, which misprices the claim |
Table 8. Place of service selection for telehealth claims. Source: CMS Place of Service Code Set.
When 98000 goes to a commercial payer that accepts it, the same POS logic applies. The code identifies the modality and the POS still identifies the location. Facility POS codes follow a different rule set, covered in the ClaimMax POS 22 billing rules. Verify your locality-adjusted rate with the CMS Physician Fee Schedule tool.
CPT Code 98000 Reimbursement: RVUs, Rates, and the Status Indicator Problem
CMS publishes relative value units and a national rate for 98000, and Medicare still won’t pay the code. Both statements hold at the same time. Billing teams that read the rate without reading the status indicator end up waiting on money that never posts.
The 2026 RVU and rate breakdown
Medicare payment runs on one formula: total RVUs multiplied by your locality geographic practice cost index, multiplied by the conversion factor. CMS finalized two conversion factors for 2026, $33.4009 for non-qualifying clinicians and $33.5675 for qualifying APM participants.
| Setting | Total RVU | National rate | Work RVU |
|---|---|---|---|
| Non-facility, office | 1.60 | $53.44 | 0.93 |
| Facility, hospital outpatient | 1.20 | $40.08 | 0.93 |
Table 9. CPT 98000 assigned RVU and national rate, CY 2026. These values are assigned, not payable under Medicare fee-for-service. Verify against CMS Addendum B before use. Source: CY 2026 Medicare Physician Fee Schedule.
Why a non-payable code still has a Medicare rate
98000 CPT code reimbursement under Medicare runs into a design quirk. CMS assigns relative values to codes it declines to pay so every code holds a defined position in the fee schedule. Status indicator I governs payability. It says nothing about valuation.
A lookup tool returning $53.44 for 98000 is reporting the assigned value, not a payable amount. Send the claim to Medicare fee-for-service and it denies regardless of what the tool displayed. Published rate figures for this code circulate without that flag attached, and billing teams price against them.
What that rate does to your commercial contract
Commercial contracts often price as a percentage of the Medicare physician fee schedule. When a contract indexes to the CMS-assigned 98000 rate, billing 98000 to that payer can return less than billing 99202 with modifier 95 for the identical encounter.
The audio-only tier shows the gap with confirmed figures. 98012 and 99212 both describe an established patient encounter at straightforward complexity with a 10-minute threshold, and the assigned values diverge by 36.5%.
| Code | Description | Total RVU | 2026 non-facility rate |
|---|---|---|---|
| 98012 | Audio-only, established, straightforward, 10 minutes | 1.13 | $37.74 |
| 99212 | In-office, established, straightforward | 1.78 | $59.45 |
| Difference | Same complexity tier | 0.65 RVU | $21.71, or 36.5% lower |
Table 10. Assigned value comparison across modality at one complexity tier. Source: CY 2026 Medicare Physician Fee Schedule national averages.
Before you switch a payer over to the 98000 series, pull the allowed amount on both codes from your last 90 days of remittances and compare the two line by line. Contract rates are negotiable, and a below-market telehealth schedule is worth raising at renewal. ClaimMax payer contract rate negotiation reviews fee schedules for CPT coverage and rate accuracy before signature. The same RVU math applied to a payable code appears in the ClaimMax 99214 Medicare reimbursement breakdown.
Run your own locality through the CMS Physician Fee Schedule rather than working from a national average, because the geographic adjustment moves the number your claims post against.
Documentation Requirements for CPT 98000
Your note has to prove three things on its own. That the patient qualifies as new, that the encounter ran on real-time audio and video, and that either straightforward MDM or the time threshold was met. Lose one and the code fails review, even on a claim that already paid.
The six elements every 98000 note needs
| # | Element | What the note must state |
|---|---|---|
| 1 | New patient status | No professional service from this provider or a same-specialty group member within the past 3 years |
| 2 | Modality | Real-time, two-way interactive audio and video, with the platform named |
| 3 | Selection basis | Straightforward MDM, or total time with the counted activities listed |
| 4 | Patient location | Home, clinic, or other site, supporting the place of service on the claim |
| 5 | Consent | Patient consented to telehealth delivery, per applicable state law |
| 6 | Clinical content | Medically appropriate history and examination as determined by the treating provider |
Table 11. Documentation checklist for a defensible 98000 claim. Source: AMA CPT E/M guidelines, CMS documentation standards.
What auditors look for first
Among the 98000 documentation requirements, reviewers start with the new patient determination and the modality statement. Both are binary, and both fall apart fast against a chart. A note reading “telehealth visit” without naming audio and video fails the second test on sight.
Write the modality into the note as a sentence, not a checkbox. Something along the lines of: this encounter was conducted using real-time, two-way interactive audio and video technology on a HIPAA-compliant platform, with the patient located at home and consent obtained before the visit.
Why CPT 98000 Claims Deny, and How to Fix Them
98000 CPT code denials cluster into five causes, and four of them start upstream of the coder. Sending 98000 to Medicare fee-for-service accounts for more denied lines than the other four combined.
The five denial patterns
| # | Denial cause | What happened | The fix |
|---|---|---|---|
| 1 | Billed 98000 to Medicare fee-for-service | Status indicator I, not payable | Rebill 99202 to 99215 with the correct POS |
| 2 | Payer never adopted the 98000 series | The contract runs on office visit codes | Confirm plan policy, rebill 99202 with modifier 95 where required |
| 3 | Modifier 95 appended to 98000 | A redundant modality flag trips an edit | Remove the modifier and resubmit |
| 4 | POS mismatch | The claim location contradicts the note | Correct the POS to the documented patient location |
| 5 | Established patient billed as 98000 | The patient was seen within 3 years | Rebill 98004 to 98007 by MDM or time |
Table 12. Common 98000 denial triggers and corresponding corrections.
What to do when a 98000 claim already denied
Pull the remittance and read the CARC and the RARC together. The CARC gives you the adjustment category and the RARC gives you the specific reason, and one without the other sends the claim into the wrong work queue.
Decide next whether the claim needs a correction or an appeal. Wrong code for the payer, wrong POS, and a redundant modifier all route to a corrected claim. Filing an appeal on those wastes the window while the clock runs.
Check the timely filing deadline before touching anything else, then fix the root cause upstream so the same denial stops repeating next week. When one denial repeats across a single payer, the payer routing rule in your billing system is the problem rather than any individual claim.
| If the same telehealth denial keeps landing under one payer, the correction sits upstream of the claim. ClaimMax denial management services sorts each denial into correction, records, or appeal, then traces the pattern back to the routing rule that produced it. Ask us to look at a 90-day sample. |
What Changes for Telehealth Billing in 2027
Nothing about the status of 98000 is scheduled to change, and the telehealth CPT codes 2026 set carries forward intact. The Medicare framework underneath the substitute codes is what moves, and a practice reading “telehealth extended” can walk away thinking 98000 turned payable.
The December 31, 2027 flexibility deadline
Medicare telehealth flexibilities run through December 31, 2027 under the Consolidated Appropriations Act, 2026. The behavioral health in-person visit waiver runs one day past that, through January 1, 2028.
Medicare telehealth CPT codes stay on the office visit series across that whole window, so the substitution rules above hold until the flexibilities lapse. Unless Congress acts again, geographic and originating site restrictions return for non-behavioral services after that date, and audio-only coverage for those services ends. Practices with a heavy telehealth panel should model that scenario now rather than in the fourth quarter of 2027.
New telehealth platform modifiers under review
CMS published the CY 2027 Physician Fee Schedule proposed rule on July 14, 2026, under CMS-1848-P, with comments due September 14, 2026. The rule proposes two telehealth platform modifiers, BB and BC, to identify services delivered through third-party virtual platforms.
Anyone planning telehealth CPT codes 2027 workflows should note the second half of the rule. CMS declined again to add 98000 through 98015 to the Medicare Telehealth Services List. Status indicator I is proposed to carry into 2027 unchanged.
Practices modeling telehealth CPT codes 2027 workflows should treat BB and BC as pending rather than active, and should keep the 98000 series off Medicare claims regardless of how the modifier proposal lands.
| Proposed is not finalNothing in the CY 2027 proposed rule takes effect on its own. Track the final rule, expected in the fall, before you change a workflow or add BB or BC to any charge master. Confirm the finalized position against CMS before publication of your own internal policy. |
Read the CMS CY 2027 proposed rule fact sheet for the summary, or the Federal Register CY 2027 rule for the full text of record.
How to Set Up 98000 Billing in Your Practice
Most 98000 problems trace back to configuration rather than coding. The code itself is straightforward. Billing systems break when one payer routing rule tries to cover a code set that needs two.
Seven steps to a clean 98000 workflow
- Flag 99441, 99442, 99443, and G2012 as invalid in the billing system so they cannot be selected at charge entry.
- Build two payer pathways. Medicare routes to 99202 through 99215 with the place of service, and commercial routes to the 98000 series wherever the plan accepts it. ClaimMax revenue cycle management builds both routes inside your existing system rather than moving you onto a new one.
- Confirm 98000 series acceptance in writing at the plan level for your top payers, and date the confirmation.
- Add patient location, technology type, and consent as required fields in the encounter template.
- Load the 98000 series into your fee schedule at charges reflecting your commercial contracts, not the Medicare assigned rate.
- Set a scrubber edit that blocks 98000 on any Medicare fee-for-service claim before submission.
- Audit 20 to 30 telehealth claims from the past 60 days for deleted codes, POS errors, and modifier mismatches.
Step 6 is the one most practices skip. A hard stop at the scrubber prevents the denial rather than working it afterward, and the difference between those two approaches is about 30 days of aging per claim.
Run the telehealth claim audit again 90 days after implementation, filtering for the same three error types under the current telehealth CPT codes 2026 rules. Patterns surface faster in a batch than they do one denial at a time.
| Setting up two payer pathways and a scrubber edit takes about half a day for someone who has built one before, and it becomes a recurring denial source for teams doing it from scratch. If your billing staff is carrying that alongside daily claim volume, ClaimMax RCM can take the build and the ongoing payer-rule tracking. Start with a free revenue cycle analysis at ClaimMax RCM. |
CPT Code 98000 Frequently Asked Questions
What is the 98000 CPT code?
The 98000 CPT code reports a synchronous audio-video telemedicine visit with a new patient at the straightforward medical decision making level. Coding by time instead of MDM, the encounter needs 15 minutes on the date of service, with 15 to 29 minutes as the practical range.
Is CPT 98000 covered by Medicare?
No. CMS assigned 98000 a fee schedule status indicator of I, meaning not valid for Medicare purposes, so a Medicare fee-for-service claim carrying the code denies. Bill 99202 through 99215 with place of service 10 or 02 instead.
What is the Medicare reimbursement rate for 98000?
CMS assigns 98000 roughly 1.60 total RVUs and a national non-facility rate near $53.44 for 2026. Medicare will not pay that amount, because status indicator I blocks payment. Treat the figure as a contracting benchmark rather than expected revenue.
Does CPT code 98000 need a modifier?
No modifier is required. The descriptor already states the service ran on synchronous audio and video, so modifier 95 repeats information the code carries. Some plans request 95 for tracking, and adding it elsewhere can trip a clearinghouse edit.
What is the time requirement for CPT 98000?
15 minutes must be met or exceeded on the date of the encounter when you select the code by total time. The practical range runs 15 to 29 minutes, since 30 minutes moves the visit into 98001. Straightforward MDM supports the code without any time threshold.
Is 98000 for a new or established patient?
New patients only. A new patient has received no professional service from the provider, or another same-specialty provider in the group, within the past 3 years. Established patient audio-video visits run 98004 through 98007 by MDM level or time.
What is the difference between 98000 and 99202?
Both describe a new patient encounter at straightforward complexity with comparable time. 98000 covers the visit delivered by audio-video and 99202 covers it in the office. Medicare pays 99202 and denies 98000, so the payer determines which one belongs on the claim.
What is the difference between 98000 and 98001?
MDM level and time threshold separate them. 98000 requires straightforward decision making or 15 minutes, and 98001 requires low complexity decision making or 30 minutes. Both cover new patient audio-video visits, and both carry identical modality and documentation rules.
What place of service is used with 98000?
Place of service 10 applies when the patient connects from home, and 02 applies from any other patient location. POS 10 prices at the non-facility rate, which pays higher than the facility rate attached to POS 02.
Does 98000 replace 99441?
99441 through 99443 were deleted on January 1, 2025 and replaced by the audio-only range, 98008 through 98015. 98000 covers audio-video encounters, so a phone visit that once billed as 99441 now maps to the audio-only codes rather than to 98000.
What is the CPT code 98000 fee schedule amount?
Medicare assigns roughly $53.44 non-facility and $40.08 facility for 2026, and pays neither under fee-for-service. Commercial rates run by contract, often as a percentage of the Medicare schedule. Pull your allowed amounts from remittances rather than relying on a published figure.
Can 98000 be billed with 99417?
No. Prolonged services code 99417 pairs with 98003 at 75 minutes and 98007 at 55 minutes within this family. 98000 sits at the lowest threshold in the new patient range, so no complete prolonged unit exists above it.
