CPT 99421: Online Digital E/M, 5-10 Minutes
CPT 99421 reports a patient-initiated online digital E/M (e-visit) with 5-10 minutes of cumulative provider time over a 7-day period. In 2026 Medicare pays about $15.70 non-facility (0.47 total RVUs times the $33.4009 conversion factor) and about $11.02 in a facility.
- Code type
- Online digital E/M (e-visit)
- 2026 non-facility
- $15.70 (0.47 RVUs)
- 2026 facility
- $11.02 (0.33 RVUs)
- Time
- 5-10 min cumulative over 7 days
What is CPT 99421 used for?
CPT 99421 reports a patient-initiated online digital E/M service, an e-visit, for an established patient, covering 5-10 minutes of cumulative physician or QHP time over a rolling 7-day period. It is the lowest of three time-based e-visit codes and captures the asynchronous work of reviewing a portal message, evaluating the problem, and responding with a plan.
The service must be genuinely evaluative, not a scheduling reply or a prescription refill with no assessment. The patient has to initiate it through a secure portal or messaging tool, the patient must be established, and the inquiry cannot relate to an E/M service the provider furnished within the prior 7 days or fall inside a procedure's global period.
How much does 99421 pay in 2026?
99421 carries 0.47 non-facility RVUs and 0.33 facility RVUs. At the 2026 conversion factor of $33.4009:
| Setting | Total RVUs | 2026 Medicare allowed |
|---|---|---|
| Non-facility | 0.47 | ~$15.70 |
| Facility | 0.33 | ~$11.02 |
It is a small payment, but it captures asynchronous work that would otherwise be uncompensated. Check locality rates with the Medicare fee calculator.
How does the 7-day window work?
The code family is billed on cumulative time within a 7-day period that starts with the provider's first review of the patient's inquiry:
- 99421 - 5-10 minutes cumulative.
- 99422 - 11-20 minutes cumulative.
- 99423 - 21 or more minutes cumulative.
Example: a patient messages about a medication side effect; the provider reviews the chart, evaluates, and replies over two portal touches totaling 8 minutes across three days. That is a single 99421 for the week, worth about $15.70, not one charge per message. When telehealth is involved, append modifier 95 if the payer requires it.
Frequently asked questions
It is a non-face-to-face evaluation and management service initiated by an established patient through a secure online portal or messaging tool. The provider reviews the inquiry, evaluates, and responds, including any related prescriptions and orders. 99421 covers 5-10 minutes of cumulative provider time over a 7-day period.
The 2026 national non-facility allowed amount is about $15.70 (0.47 total RVUs times $33.4009) and about $11.02 in a facility. It is a small payment, but it captures asynchronous work that would otherwise be uncompensated.
Do not bill it if the online inquiry relates to an E/M service you provided within the previous 7 days, or falls within the global period of a procedure. It must be patient-initiated, and the patient must be established. If the exchange leads to a same-day office or telehealth visit, the e-visit time rolls into that visit instead.
Sources & further reading
Reviewed by the ImmediCare Solutions RCM team
Certified billers and coders handling claims across 50+ specialties nationwide. This entry is reviewed against current payer policy and CMS rules. Last review: Jul 5, 2026.
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