Medical Policy Medical Policy
Policy Num: 10.001.014
Policy Name: Telemedicine
Policy ID: [10.001.014] [Ac / L / M+ / P-] [0.00.00]
Last Review: September 25, 2025
Next Review: September 20, 2026
Related Policies: None
| Popultation Reference No. | Populations | Interventions | Comparators | Outcomes |
|---|---|---|---|---|
| 1 | Individuals:
| Interventions of interest are:
| Comparators of interest are:
| Relevant outcomes include:
|
Telemedicine is the remote exchange of medical information through secure electronic communication to support diagnosis, consultation, treatment, and monitoring. “Telemedicine” and “telehealth” are often used interchangeably, although telehealth encompasses a broader range of services (eg, videoconferencing, image transmission, remote monitoring).
Its main value lies in expanding access to care for medically and socially vulnerable populations, patients in rural or underserved areas, and during circumstances that make in-person consultation impractical (eg, pandemics, mobility limitations). Evidence supports its effectiveness in improving patient satisfaction, continuity of care, and management of chronic and acute non–life-threatening conditions.
To assess the clinical utility, regulatory compliance, and medical necessity of telemedicine services in the delivery of healthcare across multiple specialties and populations.
1. Telemedicine services are medically necessary when delivered through interactive audiovisual platforms that ensure secure and confidential transmission of health information.
2. The following do not constitute telemedicine services:
3. Correct Place of Service (POS 02, 10) codes must be reported when billing telemedicine encounters.
4. Coverage is contingent on provider credentialing and contracting with Triple-S, as well as compliance with licensure and state/federal telehealth regulations.
COVID-19 emergency coverage:
Telemedicine was temporarily authorized from March 2020 (Medicare Advantage, Commercial, Plan Vital) until the emergency declarations were lifted.
Visit preparation:
Providers must confirm technology requirements, obtain patient consent, review privacy and copay expectations, and ensure audiovisual functionality.
Virtual physical exam:
Limited but focused, with visual global assessment and, when feasible, patient-assisted maneuvers guided by the clinician.
Limitations:
Telemedicine cannot fully replace in-person exams (eg, palpation, auscultation), and some patients may lack access due to the digital divide.
Clinical applications:
Primary care and urgent care
Chronic disease management: diabetes, COPD, heart failure, hypertension, obesity
Mental health and psychiatry
Specialty consultations: dermatology, ophthalmology, cardiology, endocrinology, hepatology, nephrology, neurology, perioperative care
BlueCard/National Account Issues
Benefits are determined by the group contract, member benefit booklet, and/or individual subscriber certificate in effect at the time services were rendered. Benefit products or negotiated coverages may have all or some of the services discussed in this medical policy excluded from their coverage.
Telemedicine systems allow collection and transmission of physiological data (blood pressure, ECG, glucose, INR, weight, SpO₂, etc.) for remote evaluation by providers.
Modalities include:
Synchronous (real-time): interactive video/audio
Asynchronous (store-and-forward): transmission of recorded images or data for later review
E-visits: secure electronic communication between patient and provider
Regulations vary by jurisdiction; providers must comply with CMS, HHS, ONC, and local ASES requirements.
Key considerations: billing compliance, licensure (including cross-state practice), prescribing restrictions (Ryan Haight Act for controlled substances), and HIPAA-compliant platforms.
CMS has issued telemedicine coverage determinations with approved CPT/HCPCS codes.
Telemedicine promotes healthcare equity by expanding access for rural, elderly, disabled, and socioeconomically disadvantaged populations.
Studies and systematic reviews support telemedicine in chronic disease management, behavioral health, and follow-up care, showing improved patient satisfaction and reduced hospital readmissions.
Individuals of all populations. Interventions of interest are telemidicine consultation. Comparators of interest are standard in-person consultation. Relevant outcomes include overall quality of care, quality of life and patient satisfaction.
| Population Reference No. 1 Policy Statement | [X] MedicallyNecessary | [ ] Investigational |
N/A
No specialty-specific guidelines identified beyond CMS, AHRQ, AMA, and state-level regulatory frameworks.
CMS (December 1999 memorandum, updated during COVID-19) covers percutaneous image-guided and virtual consultations when medically necessary.
Current CMS rules continue to expand telehealth coverage post-pandemic, including behavioral health and chronic disease monitoring.
| Codes | Number | Description |
| CPT
| 99201 | Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self-limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family. |
| | 99202 | Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 20 minutes are spent face-to-face with the patient and/or family. |
| | 99203 | Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Typically, 30 minutes are spent face-to-face with the patient and/or family. |
| | 99204 | Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 45 minutes are spent face-to-face with the patient and/or family. |
| | 99205 | Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 60 minutes are spent face-to-face with the patient and/or family. |
| | 99212 | Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self-limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family. |
| | 99213 | Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 15 minutes are spent face-to-face with the patient and/or family. |
| | 99214 | Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 25 minutes are spent face-to-face with the patient and/or family. |
| | 99215 | Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 40 minutes are spent face-to-face with the patient and/or family. |
| 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 | 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; 11-20 minutes of medical consultative discussion and review | |
| 99448 | 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; 21-30 minutes of medical consultative discussion and review | |
| 99449 | 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; 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 | |
| 90791 | Psychiatric diagnostic evaluation | |
| 90792 | Psychiatric diagnostic evaluation with medical services | |
| 90832 | Psychotherapy, 30 minutes with patient | |
| 90833 | Psychotherapy, 30 minutes with patient when performed with an evaluation and management service (List separately in addition to the code for primary procedure) | |
| 90834 | Psychotherapy, 45 minutes with patient | |
| 90836 | Psychotherapy, 45 minutes with patient when performed with an evaluation and management service (List separately in addition to the code for primary procedure) | |
| 90837 | Psychotherapy, 60 minutes with patient | |
| 90838 | Psychotherapy, 60 minutes with patient when performed with an evaluation and management service (List separately in addition to the code for primary procedure) | |
|
Deleted Effective 1/01/2025 | 99441 | Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian 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 |
| 99442 | Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian 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; 11-20 minutes of medical discussion | |
| 99443 | Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian 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; 21-30 minutes of medical discussion | |
| HCPCS | G0425 | Telehealth consultation, emergency department or initial inpatient, typically 30 minutes communicating with the patient via telehealth |
| | G0426 | Telehealth consultation, emergency department or initial inpatient, typically 50 minutes communicating with the patient via telehealth |
| | G0427 | Telehealth consultation, emergency department or initial inpatient, typically 70 minutes or more communicating with the patient via telehealth |
| | G0406 | Follow-up inpatient consultation, limited, physicians typically spend 15 minutes communicating with the patient via telehealth |
| | G0407 | Follow-up inpatient consultation, intermediate, physicians typically spend 25 minutes communicating with the patient via telehealth |
| | G0408 | Follow-up inpatient consultation, complex, physicians typically spend 35 minutes communicating with the patient via telehealth |
| 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 | |
| G2012 | 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 | |
|
| T1014 | Telehealth transmission, per minute, professional services bill separately |
| ICD-10 CM | | applies all diagnoses |
N/A
| Date | Action | Description |
|---|---|---|
| 9/25/2025 | Annual Review | No changes to policy statements; literature and regulatory updates confirmed up to August 2025. This Policy was presented to Physician Advisory Committee in 09/25/25 and approved |
| 3/25/2025 | Policy Replace | Review CPT Code table list. 99441, 99442, 99443 Deleted effective date 1/01/2025 |
| 10/24/2024 | Policy Review | Literature review current through: October 2024. No changes on statements. Reviwed by the Providers Advisory Committee. |
| 10/26/2023 | Policy Review | Reviewed by the Providers Advisory Committee. No changes in policy statement. |
| 11/09/2022 | Annual Review | Reviewed by the Providers Advisory Committee. No changes in policy statement. |
| 11/10/2021 | Annual Review | Reviewed by the Providers Advisory Committee. Policy Statement no changes |
| 11/11/2020 | Policy Reviewed | Reviewed by the Providers Advisory Committee. No changes |
| 7/03/2020 | Policy reviewd | CPT codes added. |
| 11/14/2019 | Policy reviewed | Policy reviewed by the Providers Advisory Committee. No changes. |
| 11/14/2018 | Policy reviewed. New Format. | Policy reviewed by the Providers Advisory Committee. A recommendation of using telemedicine to have a final assetment for patients with uncontrolled hypertension was given. Policy is open to any acute diagnosis, not life threathening. |
| 12/29/2017 | Policy reviewed | |
| 06/28/2016 | Policy reviewed | |
| 08/14/2014 | Policy reviewed | |
| 12/18/2013 | Policy created | New policy |