To address this growing reliance on digital communication, CMS has updated billing policies, enabling physicians to bill for secure patient portal messaging.
This shift has led to the introduction of new CPT® codes for “e-visits,” allowing practices to capture revenue for these services:
- 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: Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes
- 99423: Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes
HCPCS code G2012 has been deleted and replaced by CPT ® code 98016, defined as:
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 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.
These codes allow providers to bill for longer e-visit consultations conducted through secure patient portals or other digital platforms. Key requirements include:
- An established patient-provider relationship
- Adherence to specific documentation standards that meets payer criteria
- Time-based billing for asynchronous digital evaluation initiated by patients over a seven-day period per clinical episode.
While patient portal messaging increases convenience and fosters engagement, practices must establish clear policies for appropriate use. These policies should address:
- Obtaining patient consent for e-visits
- Applying clinical judgment
- Thorough documentation in the portal message
- Adherence to payer-specific rules.
Several clinical roles could help manage the workload of patient portal messages and phone calls to relieve providers:
- Nurse practitioners (NPs) can handle many routine inquiries and provide medical advice within their scope of practice.
- Physician assistants (PAs) can address many patient concerns and questions.
- Registered nurses (RNs) can triage messages, answer general health questions, and escalate complex issues to providers.
- Clinical pharmacists can manage medication-related inquiries and provide patient education on drug interactions and side effects.
- Care coordinators can handle non-clinical questions about appointments, referrals, and care plans.
- Medical assistants can manage routine administrative tasks and simple clinical inquiries under provider supervision.
- Health coaches can address lifestyle and wellness-related questions, supporting chronic disease management.
- Patient navigators can guide patients through the healthcare system, answering questions about processes and resources.
Key aspects of successful models include:
- Selective billing: Only charging for messages requiring medical expertise and taking significant time (typically five minutes or longer)
- Tiered pricing: Adjusting costs based on insurance coverage
- Clear communication: Informing patients about which types of messages may incur charges
- Low frequency: Billing for a small percentage of total messages (often less than 1%)