CPT 99423E&M

Ol dig e/m svc 21+ min

CPT 99423 is for online digital evaluation and management services lasting 21 minutes or more, where a provider responds to a patient's inquiry through a secure patient portal or similar digital communication platform. This is not a video visit—it's for written communication between visits.

Showing rates for

National Average

Base Medicare rate

$44.96

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

0.8

PE RVU (NF)

0.55

MP RVU

0.04

Total RVU

1.39

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

NCCI bundling edits

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Billing tips

Document cumulative time precisely over the seven-day period, including start and stop times for all digital communication activities (reading patient messages, reviewing records, writing responses, ordering tests)
Impact: Precise time documentation prevents denials and supports the $44.96 reimbursement; underdocumented time is the #1 reason for downcoding to 99422 (11-20 min, $32.10) or 99421 (5-10 min, $22.85)
Ensure the service originates from a patient-generated inquiry through the portal, not provider-initiated outreach, and document the patient's initiating message or concern
Impact: Patient-originated requirement is a coverage criterion; failure to document this results in 100% denial and $44.96 loss per claim
Do not bill 99423 if the digital exchange occurs within 7 days before or leads to an office visit within 24 hours; these services are considered bundled into the face-to-face E/M
Impact: Violating the 7-day/24-hour rule triggers automatic denials and potential audit flags for unbundling; can affect all 99421-99423 claims retroactively
Bill only once per seven-day period regardless of multiple message exchanges; cumulative time across all communications determines the code level (99421, 99422, or 99423)
Impact: Multiple billings within seven days for the same inquiry will be denied as duplicates; consolidate all time into single highest-level code to maximize reimbursement
Verify commercial payer coverage before providing service; not all commercial plans reimburse online digital E/M codes despite Medicare coverage
Impact: Commercial coverage varies widely; uncovered services result in patient balance billing issues and potential $44.96 write-off per encounter

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Frequently asked questions

What is the Medicare reimbursement rate for CPT code 99423 in 2025?

Medicare pays $44.96 for CPT 99423 in the non-facility setting and $38.17 in the facility setting for 2025, based on the national average using the conversion factor of 32.3465. The code has a total RVU of 1.39 (0.8 work RVU, 0.55 non-facility PE RVU, 0.04 MP RVU).

How much time is required to bill CPT code 99423?

CPT 99423 requires a minimum of 21 minutes of cumulative time spent by the physician or qualified healthcare professional over a seven-day period on the online digital evaluation and management service. This includes time reviewing the patient inquiry, related medical records, formulating and documenting a response, and any related clinical decision-making.

Can CPT 99423 be billed for new patients?

No, CPT 99423 and all online digital E/M codes (99421-99423) are only for established patients. The patient must have an existing relationship with the physician or qualified healthcare professional, or with another physician/QHP of the same specialty in the same group practice, within the past three years.

What is the difference between CPT 99423 and 99422?

The difference is cumulative time: CPT 99422 is for 11-20 minutes of online digital E/M service (paying $32.10 Medicare 2025), while CPT 99423 is for 21 minutes or more (paying $44.96 Medicare 2025). Both are patient-initiated digital communications over a seven-day period, but the higher time threshold for 99423 reflects more complex patient concerns requiring additional professional work.

Can you bill 99423 and an office visit on the same day?

Generally no. CPT 99423 cannot be billed if the online digital service occurs within 7 days before a related E/M service or leads to an E/M service within 24 hours or the soonest available appointment. If billed on the same day, the digital communication is considered part of the face-to-face visit and bundled into that E/M code.

Does CPT 99423 require a video visit or can it be a patient portal message?

CPT 99423 is specifically for asynchronous digital communication such as patient portal messages, secure email, or other non-face-to-face digital exchanges. It does NOT require video or real-time interaction. Video visits are reported with different codes such as office visit E/M codes (99202-99215) with place of service 02 or synchronous telehealth codes.

How often can CPT 99423 be billed for the same patient?

CPT 99423 can be billed only once per seven-day period per patient-initiated inquiry. If multiple message exchanges occur regarding the same concern, cumulative time is tracked across all communications within seven days and billed once at the appropriate level (99421, 99422, or 99423). A new seven-day period begins with each new patient-initiated inquiry for a distinct concern.