CPT 99422E&M

Ol dig e/m svc 11-20 min

CPT code 99422 is used when a healthcare provider spends 11-20 minutes evaluating and managing a patient's medical concern through online digital communication, such as patient portal messages or secure email. This is for asynchronous communication where the patient and provider are not communicating in real time.

Showing rates for

National Average

Base Medicare rate

$28.46

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

0.5

PE RVU (NF)

0.34

MP RVU

0.04

Total RVU

0.88

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Implement time-tracking templates in your EHR that automatically timestamp when providers start/stop responding to patient portal messages
Impact: Reduces denials by 40-60% related to insufficient time documentation; ensures accurate capture of 11-20 minute threshold
Only bill 99422 for established patients - code requires prior relationship and cannot be used for new patient inquiries
Impact: Prevents automatic denials; new patient digital inquiries are not separately billable under current CPT structure
Document cumulative time within a 7-day period, including all activities: reviewing inquiry, examining patient data/records, communicating with patient, and coordinating care
Impact: Maximizes compliant billing; many providers undercount time by excluding chart review and care coordination (average missed revenue: $85-120/month)
Verify the inquiry did not originate from an E/M within past 7 days and will not result in face-to-face visit within 24 hours
Impact: Critical compliance check; violating 7-day rule results in bundling denial and recoupment of $28.46 per instance
Train staff to flag administrative requests (appointment scheduling, prescription refills without assessment, test result notifications without evaluation) as non-billable
Impact: Prevents fraudulent billing allegations; administrative messages account for 35-50% of portal traffic but are not separately reimbursable
Consider billing 99421 (5-10 min) or 99423 (21+ min) based on actual documented time; many practices default to 99422 regardless of time spent
Optimizes revenue; undercoding 99423 loses $12.71 per encounter, while overcoding from 99421 to 99422 risks compliance issues

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 99422 in 2025?

The 2025 Medicare national average non-facility rate for CPT 99422 is $28.46, while the facility rate is $24.58. These rates are based on a total RVU of 0.88 (Work RVU 0.5, Non-Facility PE RVU 0.34, MP RVU 0.04) multiplied by the 2025 conversion factor of 32.3465.

How many minutes are required to bill CPT code 99422?

CPT code 99422 requires 11-20 cumulative minutes of physician or qualified healthcare professional time within a seven-day period. Time includes reviewing the patient inquiry, examining relevant clinical data, formulating assessment and plan, and communicating with the patient. Time spent by clinical staff does not count toward this threshold.

Can CPT 99422 be billed for new patients?

No, CPT 99422 can only be billed for established patients. The patient must have had a prior face-to-face or telemedicine E/M service with the provider or group within the past three years. New patient digital inquiries cannot be billed separately using the online digital E/M code series.

What is the difference between CPT codes 99421, 99422, and 99423?

These codes differ only by time spent: 99421 is for 5-10 minutes, 99422 is for 11-20 minutes, and 99423 is for 21+ minutes. All three codes represent online digital E/M services for established patients, require medical decision-making, and follow the same 7-day period and relationship rules. Code selection must be based on documented cumulative time.

Can I bill 99422 and an office visit on the same day?

Generally no. If the online digital service leads to an office visit within 24 hours or the next available appointment, the online service is considered bundled and cannot be billed separately. Additionally, 99422 cannot be billed if it relates to an E/M service provided within the previous seven days. The service must represent a distinct, unrelated episode of care.

Does CPT 99422 require real-time communication with the patient?

No, CPT 99422 is specifically for asynchronous (non-real-time) digital communication such as patient portal messages, secure email, or digital health platforms. If communication occurs in real-time via video or telephone, you should use synchronous telemedicine codes (99441-99443 for telephone, or time-based E/M codes with modifier 95 for video visits).

What documentation is needed to support billing CPT 99422?

Required documentation includes: verification of established patient status, the complete patient inquiry, cumulative time calculation showing 11-20 minutes within 7 days, date/timestamp of provider activities, review of pertinent clinical information, assessment with medical decision-making, care plan communicated to patient, and attestation that the service is not related to E/M within past 7 days or scheduled E/M within 24 hours.