2025 CPT Updates - Professional Evaluation & Management (E/M) and Medicine Changes

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2025 CPT Updates - Professional
Evaluation & Management (E/M) and
Medicine Changes
Ardith Campbell, COC, CPC

Disclaimer Statement
This webinar/presentation was current at the time it was published or provided
via the web and is designed to provide accurate and authoritative information
regarding the subject matter covered. The information provided is only
intended to be a general overview with the understanding that neither the
presenter nor the event sponsor is engaged in rendering specific coding advice.
It is not intended to take the place of either the written policies or regulations.
We encourage participants to review the specific regulations and other
interpretive materials, as necessary.

Agenda
 New Telephone Evaluation & Management
(E/M) Codes
 Medicine Section Changes
 Vaccines/Immunizations
 Telephone assessment & management
 Remote therapeutic monitoring (RTM) services
 Office of Inspector General (OIG) Report on
Remote Patient Monitoring (RPM)
 Guideline Changes

Introduction

Clarification of Parentheses Within a Code Descriptor
 Select the CPT code of the procedure or service that accurately identifies the
procedure or service performed. Do not select a CPT code that merely
approximates the procedure or service provided. If no such specific code exists,
then report the procedure or service using the appropriate unlisted procedure
or service code. When using an unlisted code, any modifying or extenuating
circumstances should be adequately and accurately documented in the medical
record. Furthermore, all the language within a code descriptor should be
assessed when selecting the appropriate procedure or service. This includes
information directly in the descriptor that may be enclosed in parentheses.
 57282 Colpopexy, vaginal; extra-peritoneal approach (sacrospinous,
iliococcygeus)

E/M Section

Deleted Codes
 99441 Telephone evaluation and management service by a physician or other qualified
health care professional who may report evaluation and management services provided
to an established patient, parent, or guardian not originating from a related E/M service
provided within the previous 7 days nor leading to an E/M service or procedure within
the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion
 99442 11-20 minutes of medical discussion
 99443 21-30 minutes of medical discussion
 Replacement codes: 98008, 98009, 98010, 98010, 98011, 98012, 98013, 98013, 98014,
98015

New Telemedicine Services Section Guidelines
 Synchronous, real-time interactive
encounters between physician and other
qualified health care professional (QHP)
 Uses audio-video or audio-only
telecommunication
 Level selection based on medical
decision making (MDM) or time
 Used in lieu of an in-person service when
medically appropriate
 Provided to patient and/or
family/caregiver when they agree to this
format of care

New Telemedicine Services Section Guidelines
 DO NOT use to report routine telecommunications related to a previous encounter
 Communicating laboratory results
 DO use for follow-up service when required in the same manner as in-person E/M care
 Patient requiring re-assessment for complications related to treatment plan of previous visit
 Usually not performed on the same day as another E/M
 If performed on the same date as another E/M
 Elements and time of services are summed
 Report in aggregate
 Any overlapping time is reported only once
 Only report one CPT® code

New Telemedicine Services Section
 Asynchronous services (not live in real-
time), see online digital E/M services
(99421-99423)
 Do not report telemedicine services for
oversight of clinical staff when the
service is part of another service
 Chronic Care Management
 MDM has the same meaning used in the
E/M Guidelines
 If audio-video connections are lost and
only audio restored, report the service
that accounted for the majority of the
interactive portion of the service

New E/M Codes
 98000-98016 are out of numerical
sequence
 Codes 98000-98007 for synchronous
audio-video
 Codes 98008-98015 synchronous audio-
only visits
 Separate codes for new patient versus
established patient
 98016 is different
 Medicare will not cover codes 98000-
98015
 Not listed in Appendix P and Appendix T

Synchronous Audio-Video – New Patient
 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.
 98001 Low MDM or 30 minutes must be met or exceeded
 98002 Moderate MDM or 45 minutes must be met or exceeded
 98903 High MDM or 60 minutes must be met or exceeded

Comparison of New Patient
 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.
 98000
 Synchronous audio-video visit for the
making.

Synchronous Audio-Video – Established Patient
 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.

Synchronous A-V E/M Guideline
 Codes 98000, 98001, 98002, 98003, 98004, 98005, 98006, 98007 may be reported for
new or established patients. Synchronous audio and video telecommunication is
required. These services may be reported based on total time on the date of the
encounter or MDM.
 CPT Parentheticals for 98000-98002, 98004-98006
 (Do not report 94002-94004 in conjunction with evaluation and management services
98000-98016, 99202-99499)
 (Do not report 98016 in conjunction with 98000-98015)

Synchronous A-V E/M Parenthetical Notes
 98003
 (For services 75 minutes or longer, use
prolonged services code 99417)
 (Do not report 94002-94004 in
conjunction with evaluation and
management services 98000-98016,
99202-99499)
 (Do not report 98016 in conjunction with
98000-98015)
 (Use 99417 in conjunction with 98003,
98007, 98011, 98015, 99205, 99215,
99245, 99345, 99350, 99483)
 98007
 (For services 55 minutes or longer, use
prolonged services code 99417)
 (Do not report 94002-94004 in
conjunction with evaluation and
management services 98000-98016,
99202-99499)
 (Do not report 98016 in conjunction with
98000-98015)
 (Use 99417 in conjunction with 98003,
98007, 98011, 98015, 99205, 99215,
99245, 99345, 99350, 99483)

Description of Procedure - 98000
 Prior to Visit: Review any medical records and data. Communicate with other members
of the health care team regarding the visit.
 Day of Visit: Confirm the patient’s identity. Review the medical history forms completed
by the patient. Obtain a medically appropriate history, including pertinent components
of history of present illness, review of systems, social history, family history, and allergies,
and reconcile the patient’s medications. Perform a medically appropriate visual
examination. Synthesize the relevant history and visual examination to formulate a
differential diagnosis and treatment plan (requiring straightforward medical decision
making). Discuss the treatment plan with the patient and the patient’s family. Provide
patient education, and respond to questions from the patient and/or the patient’s family.
Document the encounter in the medical record. Perform electronic data capture and
reporting to comply with the quality payment program and other electronic mandates.
 After Visit: Answer follow-up questions from the patient and/or the patient’s family, and
respond to treatment failures that may occur after the visit. Coordinate follow-up orders
with the office staff.

Clinical Vignette - 98002
 Prior to Visit: Review any medical records and data. Query the prescription monitoring
program, health information exchange, and other registries as required. Communicate
with other members of the health care team regarding the visit.
and reconcile the patient’s medications. Perform a medically appropriate visual
examination. Synthesize the relevant history, visual examination, and data elements to
formulate a differential diagnosis, diagnostic strategy, and treatment plan (requiring
moderate level of medical decision making). Discuss the treatment options with the
patient and the patient’s family, incorporating their values in the creation of the plan.
Provide patient education, and respond to questions from the patient and/or the
patient’s family. Electronically prescribe all chronic and new medications after verifying
the preferred pharmacy, making changes as needed based on the payer formulary….

 Day of Visit: …Arrange for diagnostic testing and referral if necessary. Document the
encounter in the medical record. In concert with the clinical staff, complete prior
authorizations for medications and other orders, when performed. Perform electronic
data capture and reporting to comply with quality payment programs and other
electronic mandates.
respond to treatment failures or complications or adverse reactions to medications that
may occur after the visit. Review and analyze interval testing results. Communicate
results to and plan modifications with the patient and/or the patient’s family. Respond to
queries from the pharmacy regarding changes in medications due to formulary or other
issues.

Synchronous Audio-only Visit – New Patient
 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
 All contain the phrase and more than 10 minutes of medical discussion

Comparison of Audio-Only Visit
 98008
 Synchronous audio-only visit for the
appropriate history and/or examination,
straightforward medical decision
making, and more than 10 minutes of
medical discussion.
 99202
 Office or other outpatient visit for the
making.

Audio-only New Patient
 Codes 98008, 98009, 98010, 98011, 98012, 98013, 98014, 98015 may be reported for
new or established patients. They require more than 10 minutes of medical discussion.
For services of 5 to 10 minutes of medical discussion, report 98016, if appropriate. If 10
minutes of medical discussion is exceeded, total time on the date of the encounter or
MDM may be used for code level selection.
 Parenthetical Notes
 (Do not report 94002-94004 in conjunction with evaluation and management services
98000-98016, 99202-99499)
 (Do not report 98016 in conjunction with 98000-98015)
 (For telephone services provided by a physician or other qualified health care
professional to a patient, see 98008, 98009, 98010, 98011, 98012, 98013, 98014, 98015,
98016)

Synchronous Audio-Only – Established Patient
 98012 Synchronous audio-only visit for the evaluation and management of an
established patient, which requires a medically appropriate history and/or examination,
minutes must be exceeded
 All contain the phrase and more than 10 minutes of medical discussion

CPT 98012 – Errata Example
minutes must be exceeded.
 (Do not report 98012 for home and outpatient INR monitoring when reporting 93792,
93793)
 (Do not report 98012 when using 99374, 99375, 99377, 99378, 99379, 99380 for the
same call[s])
 (Do not report 98012 during the same month with 99487, 99489) - Incorrect
 (Do not report 98012 when performed during the service time of 99495, 99496) -
Incorrect

CPT 98012 – Errata Example
minutes must be exceeded.
 (Do not report 98012 for home and outpatient INR monitoring when reporting 93792,
93793)
 (Do not report 98012 when using 99374, 99375, 99377, 99378, 99379, 99380 for the
same call[s])
 (Do not report 98012 during the same month with 99487, 99489)
 (Do not report 98012 when performed during the service time of 99495, 99496)

 Day of Visit: Review any medical records and data. Communicate with other members of
the health care team regarding the visit.
and reconcile the patient’s medications. Assess the patient’s condition with available
information to formulate a differential diagnosis and treatment plan (requiring
straightforward medical decision making). Discuss the treatment plan with the patient
and the patient’s family. Provide patient education, and respond to questions from the
patient and/or the patient’s family. Document the encounter in the medical record.
Perform electronic data capture and reporting to comply with the quality payment
program and other electronic mandates.
respond to treatment failures that may occur after the visit Coordinate follow-up or
orders with office staff.

Brief Communication Technology-Based Service
 98016 Brief communication technology-based service (eg, virtual check-in) by a physician
or other qualified health care professional who can report evaluation and management
services, provided to an established patient, not originating from a related evaluation
and management service provided within the previous 7 days nor leading to an
evaluation and management service or procedure within the next 24 hours or soonest
available appointment, 5-10 minutes of medical discussion
 Healthcare Common Procedure Coding System (HCPCS) G2012 replacement
 Video technology is not required
 Medicare will pay for 98016

98016 Guidelines
 Code 98016 is reported for established patients only. The service is patient-initiated and
intended to evaluate whether a more extensive visit type is required (eg, an office or
other outpatient E/M service [99212, 99213, 99214, 99215]). Video technology is not
required. Code 98016 describes a service of shorter duration than the audio-only
services and has other restrictions that are related to the intended use as a "virtual
check-in" or triage to determine if another E/M service is necessary. When the patient-
initiated check-in leads to an E/M service on the same calendar date, and when time is
used to select the level of that E/M service, the time from 98016 may be added to the
time of the E/M service for total time on the date of the encounter.

98016 Parenthetical Notes
(Do not report 94002-94004 in conjunction with evaluation and management services
98000-98016, 99202-99499)
(Do not report 98016 in conjunction with 98000-98015)
(Do not report services of less than 5 minutes of medical discussion)
(Do not report 99374-99380 for time reported with 98012, 98013, 98014, 98015, 98016,
98966, 98967, 98968, 99421, 99422, 99423)
(Do not report 99424, 99425 for service time reported with 93792, 93793, 98012, 98013,
98014, 98015, 98016, 98960, 98961, 98962, 98966, 98967, 98968, 98970, 98971, 98972,
99071, 99078, 99080, 99091, 99358, 99359, 99366, 99367, 99368, 99421, 99422, 99423,
99605, 99606, 99607)

98014, 98015, 98016, 98960, 98961, 98962, 98966, 98967, 98968, 98970, 98971, 98972,
99071, 99078, 99080, 99091, 99358, 99359, 99366, 99367, 99368, 99421, 99422, 99423,
99605, 99606, 99607)
98014, 98015, 98016, 98960, 98961, 98962, 98966, 98967, 98968, 98970, 98971, 98972,
99071, 99078, 99080, 99091, 99358, 99359, 99366, 99367, 99368, 99421, 99422, 99423,
99495, 99496, 99605, 99606, 99607)
98014, 98015, 98016, 98960, 98961, 98962, 98966, 98967, 98968, 98970, 98971, 98972,
99071, 99078, 99080, 99091, 99358, 99359, 99366, 99367, 99368, 99421, 99422, 99423,
99605, 99606, 99607)

98014, 98015, 98016, 98960, 98961, 98962, 98966, 98967, 98968, 98970, 98971, 98972,
99071, 99078, 99080, 99091, 99358, 99359, 99366, 99367, 99368, 99421, 99422, 99423,
99605, 99606, 99607)
(For telephone services provided by a physician or other qualified health care professional
to a patient, see 98008, 98009, 98010, 98011, 98012, 98013, 98014, 98015, 98016)

 Prior to Visit: Review any medical records and data. Communicate with other members
of the health care team regarding the visit.
and reconcile the patient’s medications. Assess the patient’s condition with available
information to formulate a differential diagnosis and treatment plan (requiring
straightforward medical decision making). Discuss the treatment plan with the patient
and the patient’s family. Provide patient education, and respond to questions from the
patient and/or the patient’s family. Document the encounter in the medical record.
Perform electronic data capture and reporting to comply with the quality payment
program and other electronic mandates.
respond to treatment failures that may occur after the visit Coordinate follow-up or
orders with office staff.

Valuation – Audio-visual
CPT Code RUC Recommended Work
RVU
CPT Code Current Work RVU
98000 0.93 99202 0.93
98001 1.60 99203 1.60
98002 2.60 99204 2.60
98003 3.50 99205 3.50
98004 0.70 99212 0.70
98005 1.30 99213 1.30
98006 1.92 99214 1.92
98007 2.60 99215 2.80

Valuation – Audio-only & Virtual Check-in
CPT Code Work RVU Assigned
98008 0.90
98009 1.55
98010 2.42
98011 3.20
98012 0.65
98013 1.20
98014 1.75
98015 2.60
98016 0.30

Telemedicine and Non-Face-to-Face Services
Service New/Est Synchronous Level/Unit
Reported
Service
Reported
Other E/M
Notations
Synchronous
audio-video
(98000-98007)
Both Yes MDM or total
time on the date
of service. No
minimum
required time,
unless level
selected by time
Per single
calendar date
Do not report
with same-day
in-person E/M
Synchronous
audio-only
(98008-98015)
Both Yes MDM or total
time on the date
of service. Must
be more than 10
minutes of
medical
discussion
Per single
calendar date
Do not report
with same-day
in-person E/M

Reported
Service
Reported
Other E/M
Notations
Brief
synchronous
communication
technology
service (98016)
Established Yes A single 5- to 10-
minute medical
discussion
Per single
calendar date
Not related to
E/M in prior 7
days or leading
to E/M in next
24 hours
Online digital
E/M (99421-
99423)
Established No Minutes during
7-day period
Per 7 days Not related to
E/M in prior 7
days or leading
to E/M in next
24 hours
All services (98000-98016, 99421-99425, 99437, 99446-99452, 99484, 99491)
Same time is not counted twice

Reported
Service
Reported
Other E/M
Notations
Interprofessional
telephone/intern
et/EHR
consultations
(99446-99451)
Both Not required Minutes during
7-day period
Per 7 days No in-person
encounter
within 14 days
Interprofessional
telephone/intern
et/EHR
consultations
(99452)
Both Not required Minutes during
a single day
Per 14 days CORRECTION:
Do not report
same day as
another E/M
Care mgmt &
remote
treatment mgmt
(99424, 99425,
99437, 99484,
99491)
Established Not required Minutes Per calendar
month
Physician or
QHP time
excluded on
date of other
E/M

Medicine Section
Updates

90661 Immunization Update
 2025
 Influenza virus vaccine, trivalent
(ccIIV3), derived from cell
cultures, subunit, antibiotic
free, 0.5 mL dosage, for
intramuscular use
 2024
 Influenza virus vaccine, trivalent
(ccIIV3), derived from cell
cultures, subunit, preservative
and antibiotic free, 0.5 mL
dosage, for intramuscular use

Immunization Updates
 Add code 90593 Chikungunya virus vaccine, recombinant, for intramuscular use
 Deleted code 90630 Influenza virus vaccine, quadrivalent (IIV4), split virus,
preservative free, for intradermal use
 90685 Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.25 mL
 90686 Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5 mL
 90689 Influenza virus vaccine, quadrivalent (IIV4), inactivated, adjuvanted, preservative
free, 0.25 mL dosage, for intramuscular use
 90694 Influenza virus vaccine, quadrivalent (aIIV4), inactivated, adjuvanted,
preservative free, 0.5 mL dosage, for intramuscular use

Immunization Updates
 Deleted code 90654 Influenza virus vaccine, trivalent (IIV3), split virus, preservative-
free, for intradermal use
 90655 Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL
 90656 Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.5 mL

Ophthalmic Diagnostic Imaging
 2025
 92132 Computerized ophthalmic
diagnostic imaging (eg, optical
coherence tomography [OCT]), anterior
segment, with interpretation and report,
unilateral or bilateral
 92133 optic nerve
 92134 retina
 2024
 92132 Scanning computerized
ophthalmic diagnostic imaging, anterior
segment, with interpretation and report,
unilateral or bilateral

OCT Angiography
 92137 Computerized ophthalmic
diagnostic imaging (eg, optical coherence
tomography [OCT]), posterior segment,
with interpretation and report, unilateral
or bilateral; retina, including OCT
angiography

92137 Clinical Example
 A 67-year-old male who has a history of
non-insulin-dependent diabetes mellitus,
notes blurred vision and is found to have
diabetic macular edema. Optical
coherence tomography (OCT) and OCT
angiography are ordered to examine the
retinal structure in depth and determine
the cause of the edema and identify any
associated foveal ischemia with non-dye
angiography.

92137 Description of Procedure
 Evaluate the quality of the study.
 Analyze and cross-reference the OCT images and numerical values to normative data.
 Reformat the images for angiography. Analyze the OCT angiography images for artifact in
comparison to the non-angiographic OCT images.
 Evaluate the OCT angiography images of the vasculature of the posterior segment at
multiple levels of the retina and choroid for evidence of ischemia, microaneurysms, and
neovascularization.
 If available, review prior studies and make a comparison for the assessment of interval
change. Enter the interpretation into the electronic health record.

Atrial Fibrillation Ablation Revision - 93656
 2025
 Comprehensive electrophysiologic
evaluation with transseptal
catheterizations, insertion and
repositioning of multiple electrode
catheters, induction or attempted
induction of an arrhythmia including left
or right atrial pacing/recording, and
intracardiac catheter ablation of atrial
fibrillation by pulmonary vein isolation,
including intracardiac electrophysiologic
3-dimensional mapping, intracardiac
echocardiography with imaging
supervision and interpretation, right
ventricular pacing/recording, and His
bundle recording, when performed
 2024
 Comprehensive electrophysiologic evaluation
including transseptal catheterizations,
insertion and repositioning of multiple
electrode catheters with intracardiac
catheter ablation of atrial fibrillation by
pulmonary vein isolation, including
intracardiac electrophysiologic 3-
dimensional mapping, intracardiac
echocardiography including imaging
supervision and interpretation, induction or
attempted induction of an arrhythmia
including left or right atrial
pacing/recording, right ventricular
pacing/recording, and His bundle recording,
when performed

Intracardiac Electrophysiological Procedures/Studies
Ablation: Once the part of the heart involved in the tachycardia is localized, the tachycardia
may be treated by ablation to the area to selectively destroy cardiac tissue. Ablation
procedures (93653-93657) are performed at the same session as electrophysiology studies
and therefore represent a combined code descriptor. When reporting ablation therapy
codes (93653-93657), the single site electrophysiology studies (93600-93603, 93610, 93612,
93618) and the comprehensive electrophysiology studies (93619, 93620) may not be
reported separately. Code 93622 may be reported separately with 93653 and 93656. Code
93623 may be reported separately with 93653, 93654, and 93656. However, 93621 for left
atrial pacing and recording from coronary sinus or left atrium should not be reported in
conjunction with 93656, as this procedure is a component of 93656. Codes 93653 and
93654 include right ventricular pacing and recording and His bundle recording when
clinically indicated. When performance of one or more components is not possible or
indicated, document the reason for not performing. Code 93656 includes each of left atrial
pacing/recording, right ventricular pacing/recording, and His bundle recording when
clinically indicated. When performance of one or more components is not possible or
indicated, document the reason for not performing.

Intracardiac Electrophysiological Procedures/Studies
 Codes 93653-93657 are combined ablation and electrophysiology studies (Eps)
 If 93653-93657, then no EP 93600-93603, 93610, 93612, 93618, 93619, 93620
 Code 93622 may be reported with 93653, 93656
 Code 93623 may be reported with 93653, 93654, 93656
 Code 93621, no 93656
 93656 includes
 Left atrial pacing/recording
 Right ventricular pacing/recording and His bundle recording when clinically indicated
 If performance of component is not possible or indicated, document the reason for not
reporting

Transcranial Doppler (TCD)
 Delete: 93890 Transcranial Doppler study of the intracranial arteries; vasoreactivity
study
 Add:
 93896 Vasoreactivity study performed with transcranial Doppler study of intracranial
arteries, complete (List separately in addition to code for primary procedure)
 93897 Emboli detection without intravenous microbubble injection performed with
transcranial Doppler study of intracranial arteries, complete (List separately in addition to
code for primary procedure)
 93898 Venous-arterial shunt detection with intravenous microbubble injection performed
with transcranial Doppler study of intracranial arteries, complete (List separately in addition
to code for primary procedure)

Transcranial Doppler - 93893
 2025
 Transcranial Doppler study of the
intracranial arteries; venous-arterial shunt
detection with intravenous microbubble
injection
 Use TCD study codes (93886, 93888, 93892,
93893) when a single study is performed.
Use 93896, 93897, 93898, when a
vasoreactivity study, emboli detection
without intravenous microbubble injection,
or venous-arterial shunt detection with
intravenous microbubble injection is
performed in conjunction with a complete
TCD on the same day.
 2024
 Transcranial Doppler study of the
intracranial arteries; emboli detection
with intravenous microbubble injection

93896
 Clinical Example: A 65-year-old female is referred to the transcranial Doppler (TCD)
laboratory after a carotid duplex ultrasound examination identified a 90% left internal
carotid artery stenosis. During the complete TCD, vasoreactivity testing is ordered to
assess cerebrovascular reserve adequacy of collateral flow. [Note: This is an add-on code.
Only consider the additional work related to vasoreactivity testing.]
 Supervise the vascular technologist with patient preparation and performance of the TCD
test as needed. Review clinical history in relation to the safety of administering carbon
dioxide (CO2) or acetazolamide. Review the recorded data, including demographics, vital
signs, and blood gases. Scan the right and left anterior circulation territories and the
posterior circulation territory to include vertebral arteries and basilar arteries. Compare
with findings from prior examinations. Assist technologist with the identification of
vessels to insonate. Review acquired Doppler spectral waveforms, flow direction, mean
systolic and diastolic flow velocities, depth of sampling, pulsatility index values, and
capnometer values throughout the duration of the CO2 administration in the resting
values for the arterial segments studied. Document procedure results. Integrate findings
with clinical presentation to formulate and document examination interpretation.

93897
 Clinical Example: A 65-year-old female is referred to the transcranial Doppler (TCD)
laboratory after presenting with a right hemisphere infarct. During the complete TCD
study, embolus detection is ordered to assess for evidence of a proximal embolic source.
[Note: This is an add-on service. Only consider the additional work related to emboli
detection.]
test as needed. Review the recorded data, including demographics, vital signs, and blood
gases. Scan the right and left anterior circulation territories and the posterior circulation
territory to include vertebral arteries and basilar arteries. Compare with findings from
prior examinations. Emboli detection is performed in the cerebral arteries to monitor
high-intensity transients consistent with thromboembolic phenomena. Document
procedure results. Integrate findings with clinical presentation to formulate and
document examination interpretation.

93898
 Clinical Example: A 50-year-old male is referred to the transcranial Doppler (TCD)
laboratory following an episode of aphasia and right hemiparesis. During the complete
TCD study, an agitated saline injection is ordered to assess for right-to-left intracardiac
shunt or pulmonary AV fistula. [Note: This is an add-on code. Only consider the
additional work related to shunt detection.]
test as needed. Review acquired Doppler spectral waveforms, flow direction, mean
systolic and diastolic flow velocity, depth of sampling, and pulsatility index values,
including waveforms obtained before, during, and after the agitated saline injection(s).
Identify and review any high-intensity, transient signal events, and classify them as
embolic or artifact. Count the total number of postinjection embolic signals and note any
“shower” or “curtain” appearance of embolic signals and the vessel segment(s) in which
they were identified. Record the relationship to the time after the intravenous injection
and to the Valsalva maneuver. Document procedure results. Integrate findings with
clinical presentations to formulate and document exam interpretation.

Electromyography Deletion
 96003 Dynamic fine wire
electromyography, during walking or
other functional activities, 1 muscle
 Deleted due to low utilization
 No suggested replacement

Genetic Counseling Update
 Delete 96040 Medical genetics and
genetic counseling services, each 30
minutes face-to-face with
patient/family
 New code 96041 Medical genetics
and genetic counseling services,
each 30 minutes of total time
provided by the genetic counselor
on the date of the encounter

Education and Training for Patient Self-Management
The following codes are used to report educational and training services prescribed by a
physician or other qualified health care professional and provided by a nonphysician
qualified health care professional using a standardized curriculum to an individual or a
group of patients for the treatment of established illness(s)/disease(s) or to delay
comorbidity(s). Education and training for patient self-management may be reported with
these codes only when using a standardized curriculum as described below. This curriculum
may be modified as necessary for the clinical needs, cultural norms, and health literacy of
the individual patient(s)….
…The qualifications of the nonphysician qualified health care professionals and the content
of the educational and training program must be consistent with guidelines or standards
established or recognized by a physician society, nonphysician health care professional
society/association, or other appropriate source.

98960 Education and Training, Individual
 2025
 Education and training for patient self-
management by a nonphysician
qualified health care professional using
a standardized curriculum, face-to-face
with the patient (could include
caregiver/family) each 30 minutes;
individual patient
 2024
management by a qualified,
nonphysician health care professional
using a standardized curriculum, face-to-
face with the patient (could include
individual patient

98961-98962 Education and Training, Group
 2025
management by a nonphysician
qualified health care professional using a
standardized curriculum, face-to-face
with the patient (could include
 98961 2-4 patients
 2024
management by a qualified,
nonphysician health care professional
using a standardized curriculum, face-to-
face with the patient (could include
individual patient

98966-98968 Telephone Assessment
 2025
 Telephone assessment and management
service provided by a nonphysician
qualified health care professional to an
established patient, parent, or guardian
not originating from a related
assessment and management service
provided within the previous 7 days nor
leading to an assessment and
management service or procedure within
the next 24 hours or soonest available
appointment;
 98966 5-10 minutes
 98967 11-20 minutes
 98968 21-30 minutes
 2024
 Telephone assessment and management
service provided by a qualified
nonphysician health care professional to
an established patient, parent, or
guardian not originating from a related
assessment and management service
provided within the previous 7 days nor
leading to an assessment and
management service or procedure within
the next 24 hours or soonest available
appointment;

Telephone Services
Telephone services are non-face-to-face assessment and management services provided by
a nonphysician qualified health care professional to a patient using the telephone. These
codes are used to report episodes of care by the qualified health care professional initiated
by an established patient or guardian of an established patient. If the telephone service
ends with a decision to see the patient within 24 hours or the next available urgent visit
appointment, the code is not reported; rather the encounter is considered part of the
preservice work of the subsequent assessment and management service, procedure, and
visit. Likewise, if the telephone call refers to a service performed and reported by the
qualified health care professional within the previous seven days (either qualified health
care professional requested or unsolicited patient follow-up) or within the postoperative
period of the previously completed procedure, then the service(s) are considered part of
that previous service or procedure. (Do not report 98966-98968 if reporting 98966-98968
performed in the previous seven days.)
(For telephone services provided by a physician, see 98012, 98013, 98014, 98015, 98016)

98970-98972 Online Digital Assessment
 2025
 Nonphysician qualified health care
professional online digital assessment
and management, for an established
patient, for up to 7 days, cumulative time
during the 7 days;
 98970 5-10 minutes
 98971 11-20 minutes
 98972 21 or more minutes
 2024
 Qualified nonphysician health care
professional online digital assessment
and management, for an established
patient, for up to 7 days, cumulative time
during the 7 days;

98975 Remote Therapeutic Monitoring (RTM)
 2025
 Remote therapeutic monitoring (eg,
therapy adherence, therapy response,
digital therapeutic intervention); initial
set-up and patient education on use of
equipment
 (Do not report 98975 for less than 16
days of cumulative monitoring during the
30-day period)
 Remote therapeutic monitoring (eg,
therapy adherence, therapy response);
initial set-up and patient education on
use of equipment

98976-98978 RTM
 Remote therapeutic monitoring (eg, therapy adherence, therapy response, digital
therapeutic intervention); device(s) supply for data access or data transmissions to
support monitoring of
 98976 respiratory system, each 30 days
 98977 musculoskeletal system, each 30 days
 98978 cognitive behavioral therapy, each 30 days
 Three main components
 Education and setup
 Device supply
 Treatment management
 Must be an established patient (waived during COVID-19)

OIG Report on Remote Patient Monitoring
 RPM rose dramatically from 2019-2022
 Used claims from Original Medicare and Medicare Advantage
 2019 had 55,000 beneficiaries receiving RPM
 2022 had 570,000 beneficiaries receiving RPM
 Payments went from $15 million to more than $300 million
 43% of the patients did not receive all three main components
 OIG and CMS have raised concerns about fraud related to RPM
 Medicare lacks key information for oversight

OIG Recommendations to CMS
 Implement safeguards to ensure RPM is used & billed appropriately
 Required that RPM is ordered & ordering provider information is included on claims
 Develop methods to identify what health data are being monitored
 Conduct provider education about billing
 Identify and monitor companies that bill for RPM

Lack of Insight
 No information about the types of health data being collected
 Blood oxygen levels, respiratory flow rate, blood pressure, and more
 No information about the types of devices that are being used
 Blood pressure cuffs, weight scales, glucose monitors
 Lacks information about what disease is being monitored
 RPM used to treat an acute or chronic condition
 7,000+ patients with diagnosis of “other specified counseling”
 500+ patients with diagnosis of “other specified health status”
 400 patient with diagnosis of “encounter for examination and observation for other specified
reasons”
 Lacks information on ordering provider and who is delivering the RPM

Questions?
Ardith Campbell, COC, CPC
hcwebinars@healthcatalyst.com

References
• MLN® Matters Evaluation and Management (E/M), MLN006764
• https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnprod
ucts/downloads/eval-mgmt-serv-guide-icn006764.pdf
• OIG Report: Additional Oversight of Remote Patient Monitoring in Medicare Is Needed
• https://oig.hhs.gov/reports/all/2024/additional-oversight-of-remote-patient-monitoring-
in-medicare-is-needed/
• List of Telehealth Services
• https://www.cms.gov/medicare/coverage/telehealth/list-services
• CPT® Errata
• https://www.ama-assn.org/practice-management/cpt/cpt-errata-technical-corrections

2025 CPT Updates - Professional Evaluation & Management (E/M) and Medicine Changes