The complexities in the field of medical billing have only increased in recent years. As the healthcare industry moves into 2025, pediatricians and medical coders have started facing a new set of challenges with recent updates in CPT pediatrics codes.
Though keeping up with pediatric CPT codes can be very overwhelming, staying updated about the new coding guidelines is important for maintaining an efficient and streamlined care for pediatric practices.
The new revisions of CPT codes bring in important modifications specific to pediatric billing services. Navigating through these changes effectively is a hectic task for pediatricians. Outsourcing it to professionals is a great way to smoothly streamline your process.
We will talk about outsourcing later in the blog but first let’s understand the key Pediatric code changes in 2025.
Major CPT Code Updates for 2025
The American Medical Association has released 420 updates in total including 270 new codes, 112 deletions, and 38 revisions. The major change in pediatric CPT codes include new codes for telemedicine, pediatric vaccine and remote therapeutic monitoring.
New telemedicine codes aim at improving accuracy while reporting remote pediatric services and ensuring appropriate reimbursement. This includes code for both audio-video and audio-only telehealth encounters. It also includes a new code for brief virtual check-ins.
Moreover, remote therapeutic monitoring codes (98975 – 98978) have been introduced that allow pediatric providers to report services related to remote monitoring of chronic conditions and mental health therapy.
These updated codes reflect the evolving healthcare needs of children that aim at enhancing the accuracy and efficiency of pediatric coding practices.
Let's Take a Look at the Primary Pediatric CPT Codes Update in 2025
Review Telemedicine Codes
A major change for pediatric CPT codes in 2025 is the introduction of new telemedicine codes for accurately capturing the delivery of remote pediatric services. These codes are designed to improve the reporting of telehealth services provided to pediatric patients. This ensures appropriate reimbursement of pediatric care.
These new codes include:
CPT Codes for Reporting New Patients in Audio-Video Telecommunications
- 98000 – Synchronous audio-video visits for evaluation of new patient with appropriate history and straight-forward decision making. The visit should be at least 15 minutes long.
- 98001 - This code requires medically appropriate history and low medical decision-making level. The visit must be 30 minutes or more.
- 98002 - This code requires medically appropriate history and moderate decision-making. When using total time on the date of encounter, it must be 45 minutes or more.
- 98003 – This code requires medically appropriate history and high medical decision making. The visit must be 60 minutes or more for this code
For Established Patient
- 98004 – Synchronous audio-video visit for evaluation and management of an established patient. This requires a medically appropriate history and straightforward medical decision-making. The visit must be at least 10 minutes long.
- 98005 - This requires medically appropriate history and low decision making. The visit for this code must be 20 minutes or longer.
- 98006 - This code requires medically appropriate history with moderate medical decision making. The total time for selecting this code must be at least 30 minutes long.
- 98007 - This code requires a medically appropriate history with a high level of decision-making. The visit must be at least 40 minutes or longer.
Pediatric CPT codes for reporting new patient's audio-only telecommunication visits
- 98008 - synchronous audio–only technology. This service requires more than 10 minutes of medical discussion. This involves straightforward medical decision making and the provider must spend 15 minutes or more per visit.
- 98009 - synchronous audio–only technology. This service needs more than 10 minutes of medical discussion. It involves low medical decision making and at least 30 minutes of total time per visit.
- 98010 - synchronous audio–only technology. This service needs more than 10 minutes of medical discussion. The visit includes moderate medical decision making and the provider must spend at least 45 minutes per visit.
- 98011 - synchronous audio–only technology. This service is applicable on visits that are more than 10 minutes. This includes a high medical decision-making level. The provider spends 60 or more minutes per visit.
For Established Patients
- 98102 - synchronous audio–only technology. This service requires more than 10 minutes of medical discussion. It involves straight forward medical decision-making level where the provider will spend more than 10 minutes of total time on the encounter day.
- 98103 - synchronous audio–only technology. This service needs more than 10 minutes of medical discussion. The visit includes a low medical decision-making level, and the provider must spend 20 or more minutes of total time on encounter date.
- 98104 - synchronous audio–only technology. The service needs more than 10 minutes of medical discussion. This involves moderate medical decision-making level where the provider spends 30 minutes of time during the visit.
- 98105 - synchronous audio–only technology. The service needs more than 10 minutes of medical decision. The visit includes high medical decision making where the provider spends 40 or more minutes of the total time.
The previous codes from 99441-99443 have been deleted and replaced by new audio-only telemedicine codes from 98008-98015. However, Medicare does not recognize these code changes and will consider them invalid for billing purposes.
New CPT Pediatrics Codes for Brief Communication
The AMA introduced pediatric CPT code 98016 in 2025 for reporting brief communication technology-based service.
98016 - Brief communication technology-based service by a physician who can report evaluation and management services, provided to an established patient not originating from a related evaluation and management service provided within the previous 7 days nor leading to an evaluation and management service or procedure within the next 24 hours or soonest available appointment, 5-10 minutes of medical discussion.
Vaccines
The CPT codes for Pediatric vaccines were updated in 2024; the updates are included in the 2025 AMA CPT Codebook. The major changes include:
- 90684: Pneumococcal conjugate vaccine, 21 valent (PCV 21), for intramuscular use
- 90624: Meningococcal pentavalent vaccine, Men B-4c recombinant proteins and outer membrane vesicle and conjugated Men A, C, W, Y-diphtheria toxoid carrier, for intramuscular use.
- 90695: Influenza virus vaccine, H5N8 derived from cell cultures, adjuvanted, for intramuscular use. This code will be in effect once FDA grants Emergency Use Authorization (EUA).
- 90593: Chikungunya Virus Vaccine, recombinant, for intramuscular use.
CPT Code 90593 follows the code 90589 and has been effective since January 1st ,2025. However, it would be included in the 2026 AMA publication.
Remote Therapeutic MonitoringRemote therapeutic monitoring (RTM) codes helps pediatric providers in the billing process for services related to initial set-up, patient education, and delivery of medical devices. Remote monitoring is very common in pediatrics, especially in the case of chronic conditions, mental health therapy and physical rehabilitation.
However, verifying the specs with the payer is very important as some plans have different rules for pediatric remote monitoring.
These services include devices for tracking patient data remotely. The CPT code revisions in 2025 include:
- 98975: Remote Therapeutic Monitoring; initial set-up and patient education on use of equipment.
- 98976: Remote Therapeutic Monitoring; supplying device(s) for data access or transmissions to support monitoring of respiratory system, every 30 days.
- 98977: Remote Therapeutic Monitoring; supply device(s) for data access or transmissions to support monitoring the musculoskeletal system, every 30 days.
- 98978: Remote Therapeutic Monitoring; supply device(s) for data access or data transmissions supporting monitoring of cognitive behavioral therapy, every 30 days.
Stay Ahead of CPT Updates with Outsourcing Services
Medical billing is already a complex path to conquer. Frequent changes only add to the complexity. The introduction of recent telemedicine codes, revised vaccine administration codes and expanded remote therapeutic monitoring services presents new challenges for medical billers and coders.
Partnering with the right medical billing and coding experts like Unify Healthcare Services is a great way to stay unharmed by the changes.
Unify Healthcare services is a well-established medical billing company that takes care of medical billing for a lot of healthcare organizations. The experts are well-versed with all the CPT pediatric codes and their latest updates. So, you can focus on patient care without figuring out ways to tackle the complexities of billing.
