What are Digital Evaluation and Management CPT Codes?

Health professionals may choose to use Digital Evaluation and Management CPT codes to report and bill for health services delivered electronically through a HIPAA-compliant platform, such as a patient portal or secure email, or a HIPAA-compliant app. 

Recently, the American Medical Association (AMA) Board of Trustees approved six new codes to replace CPT code 99444, previously used to bill for online medical evaluations.

Three of the six new codes—99421, 99422, and 99423—apply to patient-initiated digital services provided by physicians. These codes enable physicians to bill for time they spend monitoring and evaluating patients between scheduled visits.

A Digital Evaluation and Management platform like PainScript is designed specifically to capture the data needed for physicians to determine whether to bill for medically necessary services using these new CPT codes. Physicians decide whether these new codes are the right fit for their practice.

Let’s explore more about these new CPT codes and why some practices may choose to use them. 

Why are there multiple codes?

The three new CPT codes designated for use by physicians are time-based, with reimbursement dependent upon the actual time the physician, or other medically qualified personnel, spends analyzing the patient’s healthcare situation. Each time increment is captured and the total cumulative minutes spent addressing the patient’s needs must be recorded for billing in a seven-day increment.

These codes must only be used for non-face-to-face interactions and cannot be used to bill for any face-to-face or real-time virtual visits that take place within the seven-day period. 

Services for any patient-initiated online inquiries for the same (or related) issues within seven days of a previously billed E/M service are ineligible for reimbursement under the new codes. 

Physicians may use the following CPT codes to bill for online Digital Evaluation and Management services delivered to an established patient within a seven-day period. 

• 99421 for five to 10 minutes of cumulative time within seven days. Medicare reimbursement is $15.00 every seven days.
• 99422 for 11 to 20 minutes of cumulative time within seven days. Medicare reimbursement is $30.01 every seven days.
• 99423 for 21 minutes or more of cumulative time within seven days. Medicare reimbursement is $47.45 every seven days. 

The new codes do not cover physician time spent working on a patient inquiry if the total time is less than five minutes within seven days. Once a physician bills for work under the above codes, that work cannot be billed under any other codes. 

What type of physician work is eligible for reimbursement using new CPT codes?

According to the American Medical Association, the seven-day time period starts with the health professional’s review of the patient-initiated inquiry. Billable time can include the following work performed by the physician or another health professional (but not clinical staff):

• Reviewing patient information to analyze the reported issue
• Creating a care management plan
• Creating a new prescription or request for a test 
• Provider and patient communication that’s not covered by another E/M service

Monitor your patients between visits with the PainScript system 

Online Digital Evaluation and Management tools allow you to provide the quality service, care, and oversight your patients deserve. 

Digital platforms offer a unique opportunity to more closely manage your chronic pain and substance use disorder patients wherever they are. You can easily monitor their progress and needs in between scheduled face-to-face visits.

Contact PainScript to learn how we can help you significantly improve patient adherence to your prescribed medication and plan of care through an easy-to-use, clinically validated HIPAA-compliant app.

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