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.
Medicare recognizes digital evaluation and management services through the following CPT codes.
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.
Time counted toward digital E/M services may include:
Administrative tasks such as scheduling messages or brief acknowledgements do not count toward billable time.
According to CPT guidance and Medicare policy, digital E/M codes can be billed when:
These requirements help ensure the service represents a separate episode of care rather than follow up to an existing visit.
Another asynchronous service recognized by Medicare is interprofessional consultation.
CPT code 99451 can be used when a physician or qualified health professional:
This service requires at least 5 minutes of consultative time and does not require the consulting clinician to see the patient directly.
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:
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.
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.
Asynchronous care does not follow the structure of a traditional appointment.
Clinicians still need to document:
Many standard chart templates are designed for in person visits and do not easily capture this type of interaction.
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:
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.
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.
Digital E/M codes are based on cumulative time spent over a 7-day period starting with the patient’s first message.
Yes. For digital E/M billing, the patient must initiate the communication.
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.
