2025 CPT code 98967
(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 by a qualified nonphysician healthcare professional for an established patient (or guardian), lasting 11-20 minutes, not related to a service within the past 7 days or leading to a service within 24 hours.
Modifiers may be applicable depending on circumstances (e.g., modifier 59 for distinct procedural service, modifiers for place of service).
Medical necessity is established when the telephone consultation provides appropriate medical management for an established patient's acute or chronic condition, avoiding an unnecessary in-person visit.Documentation should clearly support the medical necessity for the call based on the patient's condition.
The qualified nonphysician healthcare professional is responsible for assessing the patient's condition over the phone, answering questions, providing medical advice, and documenting the encounter in the patient's chart.
In simple words: A nurse or other qualified healthcare professional talks to a patient (or their parent/guardian) on the phone for 11-20 minutes about a health problem. This call isn't about a recent visit or a visit scheduled soon, and it's about a new problem.
CPT code 98967 represents a telephone assessment and management service provided by a qualified nonphysician healthcare professional (e.g., nurse practitioner, physician assistant) to an established patient, parent, or guardian.The service must not originate from a related assessment and management service within the preceding seven days, nor should it lead to an assessment and management service or procedure within the next 24 hours or the soonest available appointment. The duration of the telephone conversation is 11 to 20 minutes.This code is specifically for telephone-only consultations; if an in-person visit is scheduled as a result of the call, this code is not used.
Example 1: A patient with an established relationship with a nurse practitioner calls to discuss persistent headaches. The NP spends 15 minutes assessing symptoms, suggesting potential causes, and recommending over-the-counter pain relief and a follow-up appointment if the headache worsens., A parent calls a physician assistant's office concerned about their child's high fever. The PA spends 18 minutes discussing symptoms, assessing the situation, and providing advice on fever management and when to seek immediate medical attention., A patient with diabetes calls their nurse practitioner to discuss concerns about a recent blood glucose reading.The NP spends 12 minutes reviewing the reading, reviewing the patient's diet and exercise regimen, and discussing necessary adjustments.
* Detailed notes documenting the patient's reason for calling.* A thorough record of the conversation, including symptoms discussed, questions answered, and recommendations made.* Documentation of the time spent on the phone call (11-20 minutes for 98967).* Confirmation that the patient initiated the call.* Verification that the call is not within 7 days of a previous service or within the postoperative period of a previous procedure.* Documentation confirming that the telephone service did not result in an in-person visit within 24 hours.
** Payers may have specific policies on the reimbursement of CPT code 98967, including limitations on the frequency and types of services covered.Always check with the payer before billing.Thorough documentation is crucial for successful reimbursement.
- Revenue Code: M5D (Specialist - Other)
- RVU: This information is not consistently provided in the source material.Consult your local payer's fee schedule for RVU values.
- Global Days: Not applicable.This is a telephone consultation, not a surgical procedure with a global period.
- Payment Status: Active, but reimbursement varies by payer.Check with individual insurers.
- Modifier TC rule: Not applicable. This is a non-surgical procedure.
- Fee Schedule: Historical fee schedule data is not available in the source material.Refer to your payer's historical fee schedules.
- Specialties:Various specialties, particularly those involving chronic care management (e.g., Cardiology, Endocrinology, Family Medicine).
- Place of Service:Office, telehealth (depending on payer policies)