What this is, in plain language
A first visit with a clinician you have not seen recently, done by live video (with audio), for a simple problem — about 15 minutes of total provider time or straightforward decision-making.
Why a clinician orders it
Establishing care or evaluating a simple new problem when an in-person exam is not needed — a cold, rash review, medication question, or follow-up on stable issues.
Medical necessity — what insurers usually look at
Coverage for telehealth is plan dependent. Many commercial plans cover video visits like office visits, but some require you to use a specific telehealth platform or network. Medicare has its own telehealth rules that have changed year to year — check your plan's current policy.
New to this? Read what medical necessity means and how to appeal a denial.
Documentation to ask about
- ✓That the visit was live audio AND video (not phone only)
- ✓Your location at the time of the visit
- ✓Reason for the visit and total time or decision-making elements
Questions for your provider
- ?Does my plan cover video visits with you, or only through a specific telehealth app?
- ?Will this be billed as a telehealth visit, and is my copay the same as in person?
Why this code is in our seed set
Part of the new CPT 98000–98015 telehealth E/M family introduced for 2025 to code synchronous audio-video visits; adoption varies by payer.
Validated against
- •AMA CPT 2025 E/M telehealth code set (98000–98015)
- •CMS telehealth services list
Terms you'll see
The insurer is reviewing whether the service is clinically appropriate for your situation.