Many clinicians assume that patient portal messages and asynchronous care cannot be billed to Medicare or insurance.
In reality, Medicare recognizes several CPT codes for digital communication and asynchronous medical evaluation.
As telemedicine continues to evolve, understanding these codes can help clinicians document and capture work they are already doing outside the exam room.
CPT Codes for Portal Messages and Digital E/M
Medicare recognizes digital evaluation and management services through the following CPT codes.
- 99421: 5 to 10 minutes of cumulative physician or qualified health professional time over 7 days.
- 99422: 11 to 20 minutes of cumulative time over 7 days.
- 99423: 21 or more minutes of cumulative time over 7 days.
These codes apply when a clinician provides medical evaluation and management through a secure digital portal.
The time is cumulative over a 7-day period beginning with the patient’s first message.
Activities That Count Toward Digital E/M Time
Time counted toward digital E/M services may include:
- reviewing the patient’s portal message
- reviewing relevant chart information or labs
- assessing symptoms or treatment response
- adjusting medications, or providing treatment recommendations
- documenting the clinical interaction
Administrative tasks such as scheduling messages or brief acknowledgements do not count toward billable time.
When Digital E/M Codes Can Be Used
According to CPT guidance and Medicare policy, digital E/M codes can be billed when:
- the patient initiates the communication
- the interaction occurs through a secure portal
- the issue is not related to a visit within the previous 7 days
- the interaction does not lead to an in person or telehealth visit within the next 24 hours or the soonest available appointment
These requirements help ensure the service represents a separate episode of care rather than follow up to an existing visit.
Asynchronous Physician Consultations
Another asynchronous service recognized by Medicare is interprofessional consultation.
CPT code 99451 can be used when a physician or qualified health professional:
- reviews patient records
- evaluates the case
- provides consultative advice to another clinician
- documents the recommendation
This service requires at least 5 minutes of consultative time and does not require the consulting clinician to see the patient directly.
How to Check Whether Medicare Covers a CPT Code
If you want to know whether Medicare recognizes a CPT code, one of the most reliable resources is the Medicare Physician Fee Schedule Lookup Tool.
The Physician Fee Schedule allows clinicians to:
- search CPT or HCPCS codes
- confirm whether the service appears in the fee schedule
- view payment indicators
- review telehealth indicators and other billing information
Many commercial insurers model their coverage policies after Medicare, which makes the Physician Fee Schedule a useful starting point even when treating privately insured patients.
Why Digital E/M Services Are Often Missed
Digital E/M services are frequently missed because the work happens in small pieces throughout the week.
For example, a patient may send several portal messages about medication side effects. The clinician reviews the chart, responds with recommendations, and adjusts treatment. Each interaction may take only a few minutes, but the total time over 7 days may meet the threshold for digital E/M billing.
Without a way to track cumulative time and document the clinical work, these services are often overlooked.
Documentation Challenges With Asynchronous Visits
Asynchronous care does not follow the structure of a traditional appointment.
Clinicians still need to document:
- the patient initiated message
- clinical review of records
- medical decision making
- cumulative time spent
- treatment recommendations or medication changes
Many standard chart templates are designed for in person visits and do not easily capture this type of interaction.
Using PMHScribe to Document Portal Message Encounters
PMHScribe includes a specialty note template designed for digital E/M and portal message encounters.
A provider can take the patient’s portal message and paste it directly into PMHScribe. The system then generates a chart note designed for this type of asynchronous encounter.
The note helps organize key documentation elements such as:
- the patient’s message or clinical question
- the clinician’s evaluation and response
- medication adjustments or treatment recommendations
- time spent reviewing the message and responding
Because portal messages do not follow the format of a traditional visit, having a dedicated note template can make it easier to document these interactions clearly and consistently.
FAQ: Billing Portal Messages and Digital E/M
Can Medicare reimburse portal message visits?
Yes. Medicare recognizes CPT codes 99421, 99422, and 99423 for digital evaluation and management services performed through a patient portal when billing requirements are met.
How long is the billing window for digital E/M services?
Digital E/M codes are based on cumulative time spent over a 7-day period starting with the patient’s first message.
Do portal messages have to be initiated by the patient?
Yes. For digital E/M billing, the patient must initiate the communication.
Can digital E/M be billed if a visit occurs right after the message?
No. If the digital interaction results in an in-person or telehealth visit within the next 24 hours or the soonest available appointment, the work is considered part of that visit.
