What this is, in plain language
A first telephone-only visit with a clinician, about 60 minutes of total provider time or high-complexity decision-making.
Why a clinician orders it
Complex new-patient evaluations by phone when video is not available — extensive records, multiple serious conditions, or high-risk medication decisions.
Medical necessity — what insurers usually look at
Plan dependent and the most likely telehealth code to be audited. Documentation must explain why a high-complexity visit could be done by phone alone.
New to this? Read what medical necessity means and how to appeal a denial.
Documentation to ask about
- ✓That the visit was audio only, and why video was not used
- ✓Your location at the time of the visit
- ✓Extensive records reviewed and total time or decision-making elements
Questions for your provider
- ?Does my plan pay for phone-only visits at this level?
- ?Will I need an in-person or video follow-up?
Why this code is in our seed set
Part of the new CPT 98000–98015 telehealth E/M family introduced for 2025.
Validated against
- •AMA CPT 2025 E/M telehealth code set (98000–98015)
- •CMS telehealth services list
Terms you'll see
Medical NecessityRead more →
The insurer is reviewing whether the service is clinically appropriate for your situation.
Important: AuraCode is an educational tool. It does not provide medical, legal, or insurance advice, claims decisions, or approval guarantees. Final coverage depends on your specific plan, eligibility, diagnosis, submitted documentation, and your insurer's review.