In simple words: This code covers a non-doctor healthcare professional's online help for an established patient (someone the provider has seen before).The professional spends 5 to 10 minutes total over 7 days answering questions, giving advice, and making a care plan using online tools. This doesn't include simple messages or appointment scheduling.

This CPT code, 98970, represents a qualified nonphysician healthcare professional's online digital assessment and management service for an established patient.The service encompasses a cumulative time commitment of 5 to 10 minutes over a seven-day period, beginning with the initial review of the patient-initiated inquiry.This cumulative time includes reviewing the initial inquiry, pertinent patient records, interaction with clinical staff, developing management plans (including prescriptions or test orders), and subsequent digital communication with the patient.All qualified nonphysician healthcare professionals within the same group practice contributing to the assessment contribute to the cumulative time.Adequate documentation and permanent storage of the encounter are mandatory. This code is not reported separately if the inquiry falls within seven days of a previous treatment/E/M service for the same problem, or within a postoperative period.If a separately reported evaluation service occurs within seven days of the initial review, codes 98970, 98971, and 98972 cannot be reported.However, if a new, unrelated problem arises during the seven-day period, the time spent assessing it is added to the cumulative service time.

Example 1: An established patient uses a secure patient portal to describe allergy symptoms. The qualified nonphysician healthcare professional reviews the patient's chart, reviews the symptoms online, and recommends an over-the-counter medication and further monitoring. The total time spent was 7 minutes., A patient with hypertension uses secure email to report increased blood pressure readings. The nonphysician professional reviews the readings, consults with the supervising physician, adjusts the medication, and schedules a follow-up appointment.The total time spent was 9 minutes., An established patient with diabetes uses a telehealth platform to ask questions about their blood sugar control. The qualified nonphysician healthcare professional answers questions, provides educational materials, and makes minor adjustments to the patient's treatment plan.The total time spent was 10 minutes.

Documentation should include the patient's initial inquiry, the qualified nonphysician healthcare professional's assessment, the management plan, details of any communication with the patient, and the total time spent over the seven-day period.All documentation must be stored permanently.

** This code is not reimbursable under Medicare.Check with individual payers for reimbursement policies.Audio-only communication is permissible.The service must be patient-initiated via a HIPAA-compliant platform, such as a patient portal or secure email.