2025 CPT code 99366
(Active) Effective Date: N/A Revision Date: N/A Evaluation and Management - Case Management Services Evaluation and Management Feed
Medical team conference; face-to-face with patient and/or family; 30 minutes or more; nonphysician qualified healthcare professional participation.
Modifiers may be applicable depending on the circumstances. Consult the CPT manual for appropriate modifier usage.
Medical necessity is established when the patient's condition necessitates the expertise and coordinated care of multiple specialties to develop an appropriate treatment plan. This is crucial for patients with complex medical situations requiring holistic management.
The clinical responsibility rests with the interdisciplinary team, with each member contributing their expertise in the patient's care plan.The non-physician qualified healthcare professional reports their time spent in the face-to-face conference with the patient and family.
- Evaluation and Management
- Evaluation and Management > Case Management Services > Medical Team Conferences
In simple words: A team of doctors and other healthcare professionals meets with a patient and their family to discuss a treatment plan.The meeting lasts at least 30 minutes, and a non-doctor on the team (like a physical therapist) bills for their participation.
This CPT code reports a medical team conference involving a minimum of three qualified healthcare professionals from different specialties.The conference includes direct (face-to-face) contact with the patient and/or family, lasting 30 minutes or more.Participating nonphysician qualified healthcare professionals (e.g., physical therapists, occupational therapists, social workers) report this code.The conference focuses on the development, revision, coordination, and implementation of healthcare services for the patient.Time spent on record-keeping and report generation is excluded.The reporting participant must be present for the entire duration of the reported time.This time cannot be used to determine time for other services, such as care plan oversight or prolonged services.
Example 1: A patient with a stroke requires the expertise of a neurologist, physical therapist, and speech-language pathologist.The team meets with the patient and family for over 30 minutes to discuss a comprehensive rehabilitation plan. The speech-language pathologist bills using code 99366., A patient with multiple sclerosis experiences both neurological and psychological challenges.A neurologist, psychiatrist, and social worker collaborate in a team conference with the patient and family. The social worker, whose input is critical to the patient's holistic treatment plan, bills using code 99366., A patient with complex diabetes requiring management by an endocrinologist, dietitian, and nurse educator.The team holds a 45-minute session with the patient to discuss medication, diet and exercise regimens, and disease self-management. The dietitian bills using code 99366.
*Detailed notes from the team conference, including attendees, time spent, specific contributions of each participant, discussion points, treatment plan developed, and any recommendations.*Patient's medical record documenting the need for interdisciplinary care.*Documentation showing the participation of at least three qualified healthcare professionals from different specialties, each providing direct patient care within the past 60 days.*Verification of face-to-face interaction of 30 minutes or more.
** Only one individual from the same specialty may report codes 99366-99368 at the same encounter.Do not report 99366-99368 when participation in the medical team conference is part of a facility or organizational service contractually provided by the organization or facility.
- Revenue Code: M1B (Office Visits - Established)
- RVU: Information not available in provided text. Consult current CPT codebook and local payer guidelines for RVU values.
- Global Days: Not applicable. This is not a surgical procedure.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Fee Schedule: Historical fee schedule information is not available in the provided text.Consult fee schedules from relevant payers and years for historical data.
- Specialties:Multiple specialties are involved, including but not limited to: Neurology, Cardiology, Endocrinology, Physical Therapy, Occupational Therapy, Speech-Language Pathology, Psychiatry, Social Work, Dietetics.
- Place of Service:Office, Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center