2025 CPT code 98966
(Active) Effective Date: N/A Revision Date: N/A Telephone Services - Non-Face-to-Face Nonphysician Services Medicine Services and Procedures Feed
Telephone assessment and management service, 5-10 minutes, by a qualified non-physician healthcare professional for an established patient.
Modifiers may be applicable depending on the circumstances of the service.Consult the CPT manual and payer guidelines for appropriate modifier usage. Modifier -95 (synchronous telemedicine) may be considered in certain telehealth contexts.
Medical necessity is established when the telephone consultation is deemed appropriate for the patient's needs and provides necessary medical advice and care. This typically includes situations where an in-person visit is not immediately required. Documentation should support the medical necessity of the telephone service.
The qualified non-physician healthcare professional is responsible for assessing the patient's condition via telephone, answering questions, providing medical advice, and documenting the encounter. This includes obtaining relevant history, conducting an assessment, making a medical decision, and communicating that decision to the patient.
In simple words: A nurse or other qualified medical professional talks to a regular patient (or their parent/guardian) on the phone about a new health problem. The call lasts 5-10 minutes and isn't related to a recent visit or a scheduled appointment soon. The patient or parent must start the call.
This CPT code reports a telephone assessment and management service provided by a qualified non-physician healthcare professional (e.g., nurse practitioner, physician assistant) to an established patient, parent, or guardian.The service involves 5-10 minutes of medical discussion and must not be related to a previous service within the last 7 days or lead to an in-person visit within 24 hours. The patient or guardian must initiate the call.
Example 1: A nurse practitioner receives a call from an established patient complaining of a new cough.The NP spends 7 minutes discussing symptoms, obtaining a brief history, recommending over-the-counter medication, and advising the patient to monitor their symptoms. Code 98966 is appropriate., A physician assistant receives a call from a patient's parent regarding a child's fever. The PA spends 9 minutes obtaining a history, discussing symptoms, recommending home care, and reassuring the parent. Code 98966 is appropriate., A nurse receives a call from a patient who is experiencing mild anxiety following a recent procedure.The nurse spends 6 minutes offering reassurance, reviewing post-operative instructions, and answering questions. Code 98966 is appropriate.
Documentation should include the date and time of the call, the patient's name and identifying information, the reason for the call, the duration of the call, a detailed description of the medical discussion, the assessment, plan of care (including any recommendations), and the patient's response.Note that the call was initiated by the patient or guardian and that it does not relate to services provided within the previous 7 days nor lead to a face-to-face visit within 24 hours.
** Many payers do not reimburse for this code, so check individual payer policies prior to billing.Accurate documentation is crucial for justifying medical necessity and avoiding denials.
- Revenue Code: M5D (SPECIALIST - OTHER)
- RVU: Information not available in source. RVUs vary by payer and location.
- Global Days: Not applicable.
- Payment Status: Active (but reimbursement varies by payer and may be limited or denied)
- Modifier TC rule: Technical Component (TC) modifier does not apply.
- Fee Schedule: Historical fee schedule data is not provided in the source.Consult payer-specific fee schedules for historical reimbursement information.
- Specialties:Multiple specialties may utilize this code, including family medicine, internal medicine, pediatrics, and others where non-physician providers frequently handle patient inquiries.
- Place of Service:Office, telehealth (depending on payer guidelines).