Telemedicine / virtual services billing updates effective Jan. 1, 2025

At Priority Health, we align our telehealth / virtual services billing guidelines with AMA, CMS and MDHHS. AMA and CMS recently released updates effective Jan. 1, 2025 – please see below how these updates apply to our plans:

New CPT telehealth codes for commercial plans

AMA introduced new telehealth-specific codes (98000-98016) effective Jan. 1, 2025. We’ll cover these codes for our commercial plans, in addition to the regular evaluation and management (E/M) codes.

The new codes are outlined in our medical policy #91604 – Telemedicine / Virtual Services. Continue to follow the billing guidance available here.

Note: Medicare doesn’t recognize these new codes, and so we aren’t covering them for our Medicare plans. Additionally, Medicaid hasn’t yet issued a 2025 fee schedule – we’ll continue to follow Medicaid’s guidelines as they’re released.

Extension to PHE telehealth flexibilities

Congress extended the COVID-19 public health emergency (PHE) telehealth flexibilities that were in place for Medicare plans through Mar. 2025. We’ll apply this extension to our Medicare plans as well.

These flexibilities loosened geographic and location restrictions on where services could be provided, and loosened limitations on the scope of practitioners who can provide telehealth services. See CMS’s MLN Matters article MM13887 for more details.