CPT code 99422 – Online digital evaluation and management

Key takeaways

CPT code 99422 covers asynchronous, patient-initiated online digital E/M services where cumulative provider time reaches 11-20 minutes within a 7-day period.

Time is added up across the 7-day window, not per message. Only one code from the 99421-99423 family may be billed per 7-day period per patient.

Medicare covers 99422 as a non-face-to-face service, not a telehealth service, and the 2026 national non-facility rate is about $29.

CPT 99442 was deleted on January 1, 2025, so audio-only calls now go to 98012-98015, or office E/M with modifier 93 for Medicare.

Pabau’s claims management software checks insurance eligibility and scrubs each claim for missing or invalid details before submitting it through Claim.MD.

CPT code 99422: Official descriptor and service definition

CPT code 99422 is the online digital evaluation and management (E/M) code for 11-20 minutes of cumulative provider time over 7 days. It covers a physician or other qualified health professional answering a patient-initiated question sent through a patient portal, EHR messaging system or another secure channel. The service is asynchronous. The patient sends a message at one time, and the provider reviews and responds at another.

The American Medical Association (AMA) maintains the CPT code set. It places 99422 in the Online Digital Evaluation and Management Services section, between 99421 (5-10 minutes) and 99423 (21 or more minutes). Three facts anchor the code’s scope.

• Patient initiation is required. The encounter cannot be provider-initiated. The patient (or their authorized caregiver) must send the inquiry.
• Established patient only. The patient must have an existing relationship with the practice, although the problem they write about may be new.
• Time is cumulative over 7 days. Multiple exchanges within a single 7-day window are added together to determine the correct tier.

CPT 99422 time requirements: Understanding the 7-day cumulative rule

Under the 7-day cumulative rule, the provider adds up all qualifying time spent on one patient-initiated inquiry across the whole window before choosing a tier. That includes reviewing patient data, writing the clinical response and documenting the encounter. It does not include time spent on an office visit scheduled within the same 7 days.

Providers must record the start and end time, or total minutes, for each review-and-response session. A note such as “12 minutes reviewing portal message and drafting response, 3 minutes documenting” is enough. Every entry in the 7-day window must be visible in the record and add up to 11-20 minutes.

CPT code 99422 vs 99421 vs 99423: Choosing the right tier

CPT 99421, 99422 and 99423 follow the same billing rules, and only the cumulative time threshold changes. Report one code from this family per 7-day period for the same inquiry, however many messages are exchanged.

Verify current rates with the CMS Physician Fee Schedule Look-Up Tool before billing, as MPFS rates change every year and vary by locality. The figures above are 2026 national non-facility estimates and shouldn’t be hardcoded into billing workflows.

CPT 99422 vs CPT 99442: What replaced the phone code

CPT 99442 was the telephone E/M code for an 11-20 minute audio-only call. The AMA deleted 99441-99443 on January 1, 2025, so it is no longer valid for current dates of service. It still turns up on claims, often in place of 99422, because both codes covered the same 11-20 minute band.

Audio-only calls with established patients now go to 98012-98015, with the level set by medical decision making or total time. Medicare does not pay those codes (status I). For Medicare patients, report the office E/M code with modifier 93, or 98016 for a brief virtual check-in. Code 98016 replaced G2012.

The diagram below maps each type of established-patient contact to the code it takes now.

Who can bill CPT code 99422?

Any physician or other qualified health professional (QHP) who can independently report E/M services may bill CPT code 99422. That includes physicians, nurse practitioners, physician assistants and similar practitioners. Two eligibility conditions apply regardless of provider type.

• Established patient relationship. The patient must already be established with the billing provider or practice. First-time contacts do not qualify.
• Clinical staff cannot report it. Clinical staff who cannot independently bill E/M services cannot report 99422. Each billing QHP uses their own NPI.

Non-physician practitioners billing 99422 must be able to bill E/M services independently under state scope of practice and payer rules. Those rules vary, so confirm with the applicable state board before billing under a non-physician NPI.

CPT code 99422 documentation requirements

Complete documentation decides whether a CPT code 99422 claim survives a payer audit. The medical record must show every element listed below. Following medical billing compliance standards helps reduce audit exposure across the board.

• Evidence of patient initiation. A dated copy or system log of the original patient message, showing the patient sent it (not a staff member on the patient’s behalf).
• Date and time of provider review. Timestamp when the provider first accessed and read the inquiry.
• Date and time of response. Timestamp when the clinical reply was sent to the patient.
• Total cumulative time. A clear note of all time spent within the 7-day period. For example, “14 minutes total, 10 reviewing labs and portal message, 4 documenting the response.”
• Clinical content of the response. The substance of the provider’s reply must appear in the record, not just “responded to patient message.”
• Medical decision making or plan of care. Any orders, referrals, medication changes, or follow-up instructions generated by the encounter.

Auditors can retract payment on a 99422 claim when any one of these elements is missing. A templated documentation note that captures each field at the time of service closes off the most common audit problem.

Medicare coverage and reimbursement rate for CPT code 99422

Medicare covers CPT code 99422 as a non-face-to-face service under the Medicare Physician Fee Schedule. It is not on the Medicare Telehealth Services List. So originating-site rules, rural geographic limits and the video-visit requirements for listed telehealth services do not apply. Payment depends on time and documentation, wherever the patient is located.

For 2026, the national non-facility Medicare rate for 99422 is approximately $29-31 ($29.39, based on 0.88 RVUs). Check the CMS MPFS Look-Up Tool for your locality-adjusted rate before billing. Rates shift with each annual MPFS update. Submit claims through a clearinghouse connected to your EHR so code edits surface before the claim reaches the payer.

Electronic remittance handling matters here. When Medicare processes an online digital E/M claim, the electronic remittance advice shows the allowed amount alongside any adjustment codes. Without automated ERA reconciliation, partial denials on these low-dollar claims are easy to miss until they reach write-off status.

Place of service codes for CPT 99422

Place of service (POS) coding is a frequent technical denial trigger on 99422 claims. Because the service is asynchronous and the patient isn’t physically present, many billing teams default to POS 02 or POS 10. Both are usually wrong for 99422.

CMS billing instructions for non-face-to-face services default to the provider’s location, which is typically POS 11. Some commercial payers diverge from Medicare and require POS 10 for any digital service. Check each payer’s requirements for online digital E/M codes before submitting.

Common claim denial reasons for CPT code 99422

Denials on CPT code 99422 cluster into six patterns. A structured denial management workflow catches most of these before they reach the payer.

• Non-established patient. Payer records show no prior visit. Verify patient status in the PM system before billing. New patients must have a face-to-face visit on file first.
• Insufficient time documentation. The record shows a response was sent but does not quantify minutes spent. Add time notation at the point of service, not after the fact.
• Same-day E/M visit bundling. Billing 99422 with a face-to-face office visit on the same date for the same condition triggers a bundling edit. The online inquiry counts as part of the visit. Some payers allow both when the inquiry covers a clearly separate issue with distinct documentation.
• Wrong POS code. POS 02 or 10 on a claim that Medicare processes as a non-face-to-face service generates a coverage edit. Use POS 11 for Medicare unless your MAC instructs otherwise.
• Provider not eligible. Clinical staff who cannot independently bill E/M services cannot report 99422. Each billing QHP uses their own NPI.
• Payer non-coverage. Some commercial payers and Medicaid plans do not cover online digital E/M services. Check coverage before the first billing date, not after a denial.

Tracking these denial codes systematically, and applying clean claim submission standards in the pre-bill scrub, helps catch most of these errors before submission.

Payer coverage beyond Medicare: Medicaid and commercial insurance

Medicare coverage for CPT code 99422 is relatively predictable. Medicaid and commercial payer coverage is not, so check each plan before the first claim goes out.

Medicaid: Coverage of online digital E/M services varies significantly by state. Some state Medicaid programs cover 99422 under telehealth parity laws, and many do not. Pandemic-era expansions that temporarily covered asynchronous services have expired in most states. Check your state Medicaid agency’s provider billing manual before billing 99422 to a Medicaid beneficiary.

Commercial payers: Many commercial plans follow Medicare’s coverage rules but add their own time thresholds, prior authorization requirements or network restrictions. Some plans require the patient to start the exchange through the plan’s own portal. Verify coverage with each payer, and record the verification date in the patient’s billing record.

Billing CPT 99422 alongside other codes

Knowing which codes you can and cannot report with 99422 prevents pre-bill edits and post-payment recoupment.

How practice management software supports CPT 99422 billing

Billing 99422 by hand means pulling minutes from several portal messages, picking the tier and then keying the claim into a separate clearinghouse. Each handoff is a chance for the time note and the claim to disagree.

Pabau, the practice management platform we build, keeps encounter documentation in the patient record. The minutes you log sit next to the message you answered. Its claims management software also verifies insurance eligibility through Claim.MD, so you know the plan is active before you bill.

For US practices, CMS-1500 claims go out through Claim.MD. Claim validation scrubs each one for missing or invalid details before it leaves, and the claims dashboard tracks it from Pending to Paid. Payments then settle straight from the ERA file.

Get 99422 claims right the first time

Pabau checks insurance eligibility, scrubs each claim for missing or invalid details and submits it through Claim.MD. See how it fits your online E/M billing workflow.

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Conclusion

CPT code 99422 pays for portal work your providers already do, but only when the record proves it. Log minutes at the moment of each reply, add them up across the 7-day window and bill one code per window.

Before release, check three details. Use the POS code your MAC expects, keep same-day visits for the same problem off the claim, and confirm the payer covers online E/M services. If your charge list still carries 99442 for phone calls, retire it in favor of 98012-98015 or Medicare’s modifier 93 route.

Book a demo to see how Pabau checks eligibility and scrubs each online E/M claim before it reaches the payer.

Continue your research

Need a clearinghouse that validates CPT and ICD-10 linkages before submission? Our Claim.MD clearinghouse guide explains how pre-submission edits catch POS and code errors before they become denials.

Want to understand how denial codes map back to root causes? Denial codes in medical billing covers CARC and RARC codes so your billing team can action remittances faster.

Unsure which POS code a non-face-to-face service takes? POS for medical practice explains how place of service codes work and which ones payers expect on a claim.

Billing remote patient monitoring alongside portal care? CPT code 99457 covers the first 20 minutes of RPM treatment management in a calendar month.

Frequently asked questions