CPT 99423: Online Digital E/M, 21 or More Minutes
CPT 99423 reports a patient-initiated online digital E/M (e-visit) with 21 or more minutes of cumulative provider time over a 7-day period. In 2026 Medicare pays about $48.77 non-facility (1.46 total RVUs times the $33.4009 conversion factor) and about $35.07 in a facility.
- Code type
- Online digital E/M (e-visit)
- 2026 non-facility
- $48.77 (1.46 RVUs)
- 2026 facility
- $35.07 (1.05 RVUs)
- Time
- 21+ min cumulative over 7 days
What is CPT 99423 used for?
CPT 99423 is the top-tier online digital E/M (e-visit) code for an established patient, covering 21 or more minutes of cumulative provider time over a 7-day period. Use it when a patient-initiated portal exchange requires substantial clinical work, review of records, decision making, coordination, and a detailed response, spread across the window.
There is no e-visit code above this one, so all cumulative time at or above 21 minutes maps here. As with the lower tiers, the patient must be established and must initiate the inquiry through a secure portal, and the exchange cannot relate to an E/M service from the prior 7 days or fall inside a procedure's global period.
How much does 99423 pay in 2026?
99423 carries 1.46 non-facility RVUs and 1.05 facility RVUs. At the 2026 conversion factor of $33.4009:
| Setting | Total RVUs | 2026 Medicare allowed |
|---|---|---|
| Non-facility | 1.46 | ~$48.77 |
| Facility | 1.05 | ~$35.07 |
It is the highest-paying of the three e-visit tiers. Confirm locality-adjusted rates with the Medicare fee calculator, and append modifier 95 if a given payer classifies the exchange as telehealth.
How do you document the top e-visit tier?
Because 99423 is the highest-paying e-visit and has no cap, it draws the most scrutiny. Build the claim on a defensible time log:
- Confirm the patient is established and initiated the inquiry through a secure portal.
- Verify no qualifying E/M occurred in the previous 7 days and no global period applies.
- Record the clinical content of the exchange and each dated interaction in the 7-day window.
- Tally cumulative provider minutes across all interactions and confirm the total is 21 or more.
Frequently asked questions
99423 requires 21 or more minutes of cumulative physician or QHP time over the 7-day e-visit period. There is no upper e-visit code, so all cumulative time at or above 21 minutes maps to 99423. Document the running total across every interaction in the window.
The 2026 national non-facility allowed amount is about $48.77 (1.46 total RVUs times $33.4009) and about $35.07 in a facility. It is the highest-paying of the three e-visit tiers.
Document that the service was patient-initiated through a secure portal, that the patient is established, the clinical content of the exchange, and a cumulative time at or above 21 minutes with enough detail to justify the top tier. Include the specific dates and interactions so an auditor can reconstruct the 7-day timeline.
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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