Telemedicine coding basics: What you need to know now
Teledermatology visits
Teledermatology services are used in lieu of an in-person visit when medically appropriate to address the care of the patient and when the patient and/or family/caregiver agree to this format of care. Teledermatology services are performed using virtual technology in one of the two ways:
Live-interactive (synchronous): A real-time, two-way interaction between the physician and the patient. For example, the patient initiates a video chat with the physician to discuss a rash. The video can be performed through everyday communication technologies such as FaceTime or Skype.
Store-and-forward (asynchronous): The patient submits an image of a lesion or video of the lesion for the physician to review and provide advice. This is a one-way interaction initiated by the patient.
To provide a teledermatology service using one of the above mentioned technologies, the clinician is required to utilize a HIPAA-compliant secure platform, such as EHR portals, secure email, or other digital applications which allow digital communication with the dermatologist/non-physician clinician (NPC).
The AMA CPT® coding manual also includes synchronous, real-time, interactive codes to report encounters between dermatologists/NPCs and a patient which utilizes either combined audio-video or audio-only telecommunication technology.
Virtual Evaluation and Management encounters
Services usually provided in-person but delivered via online, real-time audio-video or audio-only platforms should be reported with the appropriate Telemedicine and Non-Face-to-Face CPT codes for private payers or, when applicable, Medicare. Alternatively, Medicare telecommunication service codes may be used as indicated below.
As reporting requirements continue to evolve time, we recommend you contact all payers you work with to ensure you are fulfilling their telehealth coverage policies.
Teledermatology triage
Teledermatology triage (virtual check-in) is a patient-initiated, brief (5-10-minute), real-time, two-way interaction via telephone or other telecommunication device between the physician and the established patient. This service is designed to evaluate if the problem/condition warrants an office visit service and for Medicare patients, is reported with the following CPT/HCPCS code:
Medicare patients only:
98016 Brief communication technology-based service, e.g. 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 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.
All other payers and Medicare:
98016 Online digital E/M Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes
Online communications
Teledermatology services where the patient initiates a one-way communication by submitting an image or records a video of the condition for which he/she is seeking an evaluation. This type of service, when provided to Medicare beneficiaries is reported with the following HCPCS code:
G2010 Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store-and-forward), including interpretation with follow-up with the patient within 24 business hours, 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
Online virtual encounters when reported to all other payers are reported based on cumulative time during a 7-day period are reported with the following CPT codes:
99421 Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes
99422 11-20 minutes
99423 21 or more minutes
Dermatologist to other physician communications
Dermatologists can also provide telehealth consultation services to another physician. Consultation services provided between physicians are reported with interprofessional consultation codes 99446 - 99452 with POS code 11 and modifier 95 to indicate that the service was provided using HIPAA-compliant communication technology.
These consultations can happen on a telephone call (both audio only or audio/video), or on an internet or electronic health record (EHR portal) and are based on time.
99446 Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including a verbal and written report to the patient’s treating/requesting physician or other qualified health care professional; 5-10 minutes of medical consultative discussion and review
99447 11-20 minutes of medical consultative discussion and review
99448 21-30 minutes of medical consultative discussion and review
99449 31 minutes or more of medical consultative discussion and review
99451 Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including a written report to the patient’s treating/requesting physician or other qualified health care professional, 5 minutes or more of medical consultative time
99452 Interprofessional telephone/Internet/electronic health record referral service(s) provided by a treating/requesting physician or other qualified health care professional, 30 minutes
More information on coding for dermatology encounters can be found in the resources at the bottom of this page and in our page on telehealth flexibilities.
Telemedicine coding tables for 2025
See our guidance on teledermatology and non-face-to-face services.
Access tablesTeledermatology FAQs
Q1. Which modifier is appropriate for both commercial and Medicare insurance?
A1. Telehealth modifiers are specific to each private payer however Medicare requires modifier 93 Synchronous Telemedicine Service Rendered Via Telephone or Other Real-Time Interactive Audio-Only Telecommunications System OR 95 Synchronous Telemedicine Service Rendered via a Real-Time Interactive Audio and Video Telecommunications System to be appended to an encounter claim depending on what type of technology was used to provide the service(s).
As reporting requirements continue to evolve during this time, we recommend you contact all private payers you work with to ensure you are fulfilling their telehealth coverage policies.
Q2. If an established patient sends a picture of a lesion via email and the doctor responds via email, what code do we report?
A2. This scenario describes a “store-and-forward” encounter.
The patient-initiated the review of a lesion by the dermatologist via email or other electronic technology. The dermatologist reviews the image and responds to the patient with a diagnosis and treatment plan.
For this service, you can bill Medicare using G2010 remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, 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.
For private payers, you can bill one of the following codes depending on time spent.
99421 Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes
99422 11-20 minutes
99423 21 or more minutes
Q3. Unless specifically stated in the code descriptor, level selection for CPT telemedicine services is based on either the level of medical decision making (MDM) or the total time for E/M services performed on the date of the encounter, as defined for each service.
A3. Yes, telemedicine services are used in lieu of an in-person service when medically appropriate to address the care of the patient and when the patient and/or family/caregiver agree to this format of care and may be used for follow-up of a previous encounter, when a follow-up E/M service is required, in the same manner as in-person E/M services are used. Determination of the level of service is based on medical decision making or total time spent on medical discussion with the patient.
Q4. Can I bill a Medicare patient if the virtual encounter service was rendered by telephone only? What code should be reported?
A4. Yes, synchronous audio-only evaluation and management services can be reported with CPT codes 98008-98015. The codes are based on the total time spent discussing the patient’s condition. Please check the table above for specific code selections.
Note: AMA CPT telemedicine codes 98000-98015 cannot be reported to CMS for services rendered to Medicare beneficiaries. However, CPT code 98016 (virtual check-in) can be reported for services rendered to Medicare beneficiaries in lieu of G2012.
