Question: When our otolaryngologists perform online digital E/M services (99421-99423) services, what activities count toward cumulative service time? Pennsylvania Subscriber Answer: According to CPT® the physician’s cumulative service time includes: Any subsequent communication with the patient through online, telephone, email, or other digitally supported communication, which does not otherwise represent a separately reported E/M service. Important: “All professional decision making, assessment, and subsequent management by physicians or other QHPs in the same group practice contribute to the cumulative service time of the patient’s online digital E/M service,” per CPT®.