Charged for a patient portal message? E-visit codes and what they cost

Why a message can become a bill

For years, a message through a patient portal was treated as a courtesy, folded into the cost of the last visit. That changed when payers began recognizing online digital evaluation and management as a service of its own. Medicare.gov describes e-visits as non-face-to-face communications you have with your doctor or other health care provider using an online patient portal, covered by Part B, and adds that to get an e-visit, you must ask your provider for one. In practice, "asking" is often the act of sending a clinical question through the portal, and the practice decides afterward, from the clinician's time and the content of the exchange, whether it meets the definition of a billable service.

CMS described the rules when it first explained these codes, in its March 17, 2020 telemedicine fact sheet for providers. E-visits are for established patients of the billing practice; the patient must generate the initial inquiry; and the communications can occur over a seven-day period. The codes are tiered by the clinician's cumulative time in that period: 5 to 10 minutes, 11 to 20 minutes, and 21 minutes or more. That fact sheet was written during the pandemic emergency, so we use it here only for those definitions, and take today's cost sharing from Medicare.gov.

Three consequences follow from that definition. A message the patient did not start, such as a results notice the office sends you, is not an e-visit. A message to a practice you have never seen is outside the established-patient rule. And because time is measured cumulatively over up to seven days, a back-and-forth about one problem is meant to be one service, billed at whatever time tier the clinician's total reached, not one charge per message.

What each code pays: CY2026 Medicare anchors

The amounts below are CY2026 Medicare Physician Fee Schedule amounts for Michigan Locality 01, computed by MyCarePrice from the CMS RVU26D relative value file (October 2026 release), the CY2026 geographic indices and the $33.4009 conversion factor. The nonfacility column applies to a practice billing as a physician office; the facility column applies when the clinician bills as part of a hospital or facility setting.

Source: CMS PFS RVU26D and GPCI2026, Michigan Locality 01, CY2026. Computed and checked October 30, 2026. Coinsurance column assumes the 2026 Part B deductible of $283.00 is already met. Medicare anchors, not your bill.

The table answers the question most people ask after seeing the charge: how big is it really? In Medicare terms, the shortest e-visit is $15.92, and a person with Original Medicare who has met the deductible owes $3.18 of it. The longest tier is $49.20, with a 20 percent share of $9.84. For comparison, an established-patient office visit at the low-complexity level, 99213, is $95.55 in the same locality, $64.35 more than a mid-tier e-visit under 99422. A message is not free when it is billed, but it is priced well below a visit.

The first three rows are for physicians and other clinicians who bill evaluation and management services, such as nurse practitioners and physician assistants. The second three, 98970 to 98972, carry the short descriptor "Nqhp ol dig assmt&mgmt" in the CMS file, shorthand for an online digital assessment by a qualified nonphysician health care professional, the kind of clinician who does not bill evaluation and management codes. They pay less for the same time tier.

The seven-day window, worked through

The cumulative time rule is what makes portal billing checkable. As an illustration with stated inputs: suppose you send a clinical question on a Monday, the clinician spends 6 minutes reviewing your chart and replying, you send a follow-up on Wednesday, and the clinician spends another 7 minutes. Within one seven-day period the cumulative time is 13 minutes, which falls in the 11 to 20 minute tier. Under the definition, that is one service billed as 99422, $31.20 in the Medicare anchor, not two services at 99421. A person with Original Medicare who has met the deductible would owe 20 percent, $6.24.

Now suppose a new, unrelated question goes in ten days after the first one. That falls outside the first seven-day period and can start a new service. Two charges two weeks apart are consistent with the rule; two charges for the same conversation in the same week are a fair question for the billing office. Ask which dates each charge covers and the minutes documented for each.

Time also has a floor. The shortest tier starts at 5 minutes of cumulative clinician time. A one-line reply that took a minute of the clinician's time does not reach the first tier under the definition, and many health systems publish lists of message types they do not bill, which typically include scheduling, prescription refill requests and follow-ups shortly after a visit. Those lists differ by system, so read the one your portal links to.

A worked month with three threads

As an illustration with stated inputs: a person with Original Medicare has already met $200.00 of the $283.00 Part B deductible for 2026. In one month they start three separate, unrelated message threads, each more than seven days apart. The practice bills the first as 99421, the second as 99422 and the third as 99423, according to the clinician's cumulative minutes on each.

The example shows why early-year portal charges feel larger than the coinsurance column suggests: while the deductible is open, the patient pays the whole approved amount. It also shows that each thread stands alone. Had the second and third questions been part of the first thread, inside the same seven days, the clinician's cumulative time would have been tiered once, and there would have been one charge instead of three.

What to look for in your health system's policy

Practices that bill for portal messages usually publish a policy page, often linked from the portal's message screen. The policies differ, so read yours with these questions in mind, and keep a copy or screenshot with the date you read it:

• Which message types does the policy say are never billed? Look for scheduling, refills, forms, test result questions and follow-ups after a visit.
• Is there a time window after a visit during which related questions are not billed, and how long is it?
• Does the portal warn you before you send a message that it may be billed, and can you withdraw the message at that point?
• Who decides whether a message is billed, and can you ask for a review afterward?
• How will the charge be labeled on your statement, and with which date?
• Does the policy apply to messages sent from a proxy or caregiver account on your behalf?

A policy is the practice's own commitment, and it is the most useful document in a dispute about whether a message should have been billed. A charge that contradicts the published policy is the easiest kind to have reversed.

Virtual check-ins: a different, shorter code

Not every quick contact is an e-visit. Medicare.gov describes virtual check-ins as brief communications with your doctor by real-time audio or video, usually 10 minutes or less, and notes that a provider may also review photos or videos you send to decide whether you need an office visit. You must have discussed starting these services with your provider and give verbal consent, which the provider records; one consent can cover a year of these services. After the deductible you pay 20 percent of the approved amount.

Source: CMS PFS RVU26D and GPCI2026, Michigan Locality 01, CY2026. Computed and checked October 30, 2026. Medicare anchors, not your bill.

The original virtual check-in code was G2012. In the CY2026 CMS file it no longer appears, and code 98016, described as a brief communication technology-based service, carries the payment, which is why a newer statement may show 98016 for the same kind of contact. When CMS explained G2012 in 2020, it set two conditions that still frame these services: the check-in must not originate from a related visit within the previous seven days, and must not lead to a visit or procedure within the next 24 hours or the soonest available appointment. In other words, a check-in that ends with "come in tomorrow" is folded into the visit that follows, and a question about last week's visit is folded into that visit. G2010, the review of photos or video you send, follows the same two conditions under the 2020 description.

What a commercial plan does with the charge

Outside Medicare, the same codes are billed to the plan, and the plan's contract with the practice sets the allowed amount. Your share depends on how the plan classifies the service. Some plans treat an e-visit like an office visit and apply the office copay or the deductible; some treat it as telehealth with its own cost sharing; some cover it with no cost sharing. That variation is why two patients at the same health system can see very different amounts for the same code.

This example is hypothetical. The allowed amount and plan design are invented to show the arithmetic. Suppose a plan's allowed amount for 99422 at a given practice is $40. If you have not met your deductible and the plan applies the deductible to e-visits, you pay the full $40, and it counts toward the deductible. If the plan instead applies a $10 virtual-care copay, you pay $10. If the plan covers e-visits with no cost sharing, you pay nothing. Same code, same practice, three different patient amounts, decided entirely by plan design. The question to put to the plan is narrow: "How do you process CPT 99421 to 99423, and do they apply to my deductible?"

If you have a high deductible health plan, one more rule can apply. IRS Publication 969, the edition for 2025 returns, says a plan will not fail to be treated as a high deductible health plan because it has no deductible for telehealth, and that treatment is now permanent. Whether your plan uses that permission, and whether it counts a portal e-visit as telehealth for the purpose, is a plan decision. The telehealth cost guide explains the rule and the visit-level anchors for video visits, and the HDHP cost math guide shows how pre-deductible coverage enters a full-year comparison.

How to read the charge on your statement

Portal charges are labeled inconsistently. A statement can show the CPT code, a short descriptor such as "online digital E/M service", or only a generic line with the clinician's name and a date. The explanation of benefits from your plan usually shows the code and the date of service. Because an e-visit can span up to seven days, its date of service may not be the day you sent the message, so match by the week rather than the day.

Put the statement next to your portal's message history. The history shows when you sent each message and when the replies came, which is the record that settles whether two charges overlap. How to read an explanation of benefits shows where the code, the allowed amount and your share appear on the plan's statement.

Before you send: a short checklist

• Is this administrative, such as scheduling, a refill request or a form? Send it separately from any clinical question, or through the channel the portal designates for it.
• Does it relate to a visit within the last week? Say so in the message, so the reply can be tied to that visit.
• Will the answer need the clinician's review of your chart or a decision? That is the kind of exchange the e-visit codes describe.
• Do you have a visit coming up soon? A question that can wait for it will not produce a separate line.
• Are you unsure? Ask the office before sending whether a message like yours is usually billed under its policy.

None of this is a reason to avoid contacting a clinician when you need to. It is a way to make the billing predictable. If you are uninsured or paying yourself, ask the practice for its cash price per e-visit tier, the same way you would ask for any service; the cash price guide has the wording.

Questioning a portal charge

Work in the order you would for any bill: documents first, then a call, then a decision about payment. Gather the statement line, the explanation of benefits if you used insurance, and the portal history for the week in question. Then state the disagreement in one sentence with a date in it. Examples that can be checked: "My message on the 4th was a refill request, which your published policy says is not billed." "These two charges cover messages on the 4th and the 6th about the same question, which should be one seven-day service." "This message was a follow-up to my visit on the 2nd." A general complaint that messages should be free cannot be checked; one of these can.

Call the practice's billing office, not the clinician's inbox, and ask whether it will review the charge against its policy and the documentation. Ask what happens to the balance while the review runs. If the practice agrees the message was not billable, ask for a corrected statement and, if a plan processed the claim, a corrected claim to the plan, so the explanation of benefits matches. The itemized-bill check gives the full procedure for any disputed line.

If the charge is correct, it is still small in Medicare terms, and it counts toward the Part B deductible like other covered services. For a person on a tight budget, the more useful step is prevention: before sending a clinical question, check the portal's notice about billing, or ask the office whether the question would be better handled at a visit you are already scheduled for.

One thread, two clinicians: when two code families appear

Medicare.gov lists the clinicians who can provide e-visits: doctors, nurse practitioners, clinical nurse specialists, physician assistants, physical therapists, occupational therapists and speech-language pathologists, and, for mental health care, licensed clinical social workers, clinical psychologists, marriage and family therapists and mental health counselors. That list mixes clinicians who bill evaluation and management services with clinicians who do not, which is why the CMS fee file carries two sets of portal codes: 99421 to 99423 for clinicians who bill evaluation and management services, such as physicians and nurse practitioners, and 98970 to 98972 for qualified nonphysician professionals who do not, such as physical therapists.

As an illustration with stated inputs: you message your clinic about a knee that is not improving after physical therapy. The physical therapist reads the thread, spends 8 minutes reviewing your exercises and replying, and passes the question to your physician, who spends 12 minutes on the same thread two days later. If each clinician's time is billed under that clinician's own code family, the statement can show 98970 at $12.46 and 99422 at $31.20, $43.66 in Medicare anchors, and a person who has met the deductible owes 20 percent, $8.73. Had one physician spent all 20 minutes, the thread would have tiered once at 99422, and 21 minutes would have reached 99423, with a 20 percent share of $9.84.

Two lines for one thread are not automatically an error, but they are worth one question: whose minutes are on each line, and were any minutes counted on both? The portal history shows who replied and when, so you can match each line to a reply. Medicare.gov also notes that what you pay can depend on what the clinician charges and whether the clinician accepts assignment, so a second clinician outside the practice that billed the first line can produce a different share for the same minutes. If the two clinicians work in the same practice, ask the billing office to show the documented time for each code; if one line has no reply from that clinician in your history, ask for it to be reviewed.

If you are uninsured or on a different kind of coverage

A patient without insurance who sends a clinical question can be billed the practice's own charge for the e-visit code, with no plan in between. The Medicare anchors above are a yardstick for that charge, not a limit on it. Ask the practice for its self-pay price for each time tier before relying on portal messages for clinical questions, and ask whether its financial assistance or discount policy applies to e-visits as it does to office visits. If you are in a Medicare Advantage plan, the plan sets its own cost sharing for these codes, which can differ from the 20 percent of Original Medicare; the plan's Evidence of Coverage, or a call to the plan, gives the figure. For Medicaid, coverage and cost sharing for e-visits are set by each state program, so the state's member handbook or the plan's member services line is the place to ask.

Whatever the coverage, the same three facts settle any portal charge: the code, the dates the service covers, and the minutes the clinician documented. Ask for all three when a charge is unclear.

Portal charge questions, answered

The rules and fee files behind each figure

• Medicare.gov, E-visits: definition, patient request, the clinicians who can provide e-visits, Part B cost sharing. Checked October 30, 2026.
• Medicare.gov, Virtual check-ins: definition, consent, cost sharing. Checked October 30, 2026.
• CMS, Medicare Telemedicine Health Care Provider Fact Sheet, March 17, 2020: e-visit definitions (established patient, patient-initiated, seven-day period, time tiers) and the G2012 and G2010 conditions. Used for definitions only. Checked October 30, 2026.
• CMS, Physician Fee Schedule relative value file RVU26D (October 2026 release) and CY2026 GPCIs, Michigan Locality 01, $33.4009 conversion factor: every code amount on this page, and the absence of G2012 from the 2026 file. Computed October 30, 2026.
• Medicare.gov, Medicare costs: 2026 Part B deductible of $283. Checked October 30, 2026.
• Internal Revenue Service, Publication 969 (for 2025 returns): telehealth and the high deductible plan rule. Checked October 30, 2026.

General billing information, not medical, legal or insurance advice. Medicare anchors are not your bill. Confirm your price in writing before service.