Ol dig e/m svc 21+ min
CPT 99423 is used when a healthcare provider spends 21 minutes or more conducting an online digital evaluation and management service, such as responding to a patient portal message or reviewing and responding to patient-submitted photos or data.
RVU breakdown
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
Billing tips
Document cumulative time precisely in minutes (not ranges) over the 7-day period, including date/time stamps for each interaction
Impact: Prevents denials and downcoding; undocumented time is the #1 reason for claim rejection, potentially losing the full $44.96 reimbursement
Ensure 21+ minutes of documented physician/QHP time - do not include staff time, patient time, or administrative tasks
Impact: Services with 11-20 minutes should use 99422 ($27.84), resulting in $17.12 underpayment if 99423 is denied and downcoded
Do not bill 99423 for the same issue within 7 days of a related E&M service or if it leads to an E&M within 24 hours
Impact: Bundling edits will deny the claim; the service becomes part of the originating or subsequent E&M visit
Verify patient portal or platform meets HIPAA compliance and secure messaging requirements before billing
Impact: Non-compliant platforms can trigger payer audits and full claim denial with recoupment
Bill only once per 7-day period per patient, even if multiple interactions occur; cumulate all time into single claim
Impact: Multiple claims for the same 7-day period will be denied as duplicates, creating administrative burden and payment delays
Obtain patient consent for online digital E&M services and document in the medical record per CMS requirements
Impact: Missing consent documentation can trigger compliance violations and payer recoupment during audits
Common denials
Insufficient documentation of time spent on the digital interaction
How to appeal: Submit detailed time log with date/time stamps for each component of the service (review time, research time, response composition time) with screen captures or portal audit trail showing cumulative 21+ minutes
Service billed within 7 days of related office visit or led to visit within 24 hours
How to appeal: Provide documentation showing the online service addressed a separate, unrelated condition or problem, with clear differentiation in diagnosis codes and clinical documentation
Payer does not recognize or cover online digital E&M codes
How to appeal: Submit policy update requests citing CPT code validity since 2019 and CMS coverage; consider appealing with reference to telehealth parity laws in your state; may need to write off for payers with explicit non-coverage policies
Service coded as administrative or non-covered preventive communication
How to appeal: Resubmit with detailed clinical documentation demonstrating medical decision-making, assessment of patient condition, and management plan; highlight diagnostic or therapeutic nature versus administrative coordination
Frequently asked questions
What is CPT code 99423 used for?
CPT 99423 is used to bill for online digital evaluation and management services that require 21 minutes or more of cumulative physician or qualified healthcare professional time over a 7-day period. This includes patient portal messages, secure email consultations, and review of patient-submitted photos or data that require medical assessment and management.
How much does Medicare pay for CPT 99423 in 2025?
In 2025, Medicare pays $44.96 for CPT 99423 in non-facility settings and $38.17 in facility settings based on the national average. The code has a total RVU of 1.39 (0.8 work RVU, 0.55 non-facility PE RVU, 0.04 MP RVU) using the 2025 conversion factor of 32.3465.
What is the difference between 99421, 99422, and 99423?
These codes differ only by time: 99421 covers 5-10 minutes, 99422 covers 11-20 minutes, and 99423 covers 21+ minutes of cumulative physician/QHP time over a 7-day period for online digital E&M services. All other requirements (patient-initiated, secure platform, documentation) remain the same across the code family.
Can I bill 99423 and an office visit on the same day?
No, you cannot bill 99423 if it relates to an E&M service provided within the previous 7 days or if the online inquiry leads to an E&M service within the next 24 hours. The online service becomes bundled into the office visit. You can only bill separately if the online service addresses a completely unrelated condition.
Do I need patient consent to bill CPT 99423?
Yes, CMS and most payers require documented patient consent for online digital E&M services before billing codes 99421-99423. The consent should inform patients that these services may result in cost-sharing obligations and should be documented in the medical record.
What counts toward the 21 minutes for CPT 99423?
Only physician or qualified healthcare professional time counts: reviewing patient inquiry, examining submitted photos/data, researching the condition, formulating assessment and plan, and composing the response. Staff time, patient time writing the message, and purely administrative tasks do not count toward the time threshold.
Is CPT 99423 covered by all insurance companies?
No, coverage varies significantly. Medicare covers 99423 as shown by the published fee schedule rates. Many commercial payers have adopted coverage, especially post-COVID, but some still consider these services non-covered or bundled. Always verify coverage with specific payers before providing the service, and inform patients of potential out-of-pocket responsibility.