2025 CPT code 98971
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Evaluation and Management - Non-Face-to-Face Nonphysician Services Medicine Feed
Qualified nonphysician healthcare professional online digital assessment and management for an established patient; 11-20 minutes of cumulative time over 7 days.
Modifiers may apply depending on the specific circumstances of the service, such as modifier 24 (unrelated E/M service) or other relevant modifiers.
Medical necessity is established when the online assessment and management service is appropriate for the patient's condition, is consistent with the established plan of care, and avoids unnecessary or redundant services. The services should be clinically appropriate, and the time spent should reflect the complexity of the situation.Payer guidelines will determine further specifications.
The qualified nonphysician healthcare professional is responsible for assessing the patient's online inquiry, reviewing relevant medical records, developing a management plan, ordering tests or prescribing medications as needed, and communicating the plan to the patient using online communication technologies.Documentation of the entire encounter is the responsibility of the clinician.This includes any phone calls, email exchanges, or other communications associated with the online encounter.
In simple words: A nurse practitioner or similar healthcare professional spends 11-20 minutes over 7 days communicating online with a returning patient about a health issue, answering questions, creating a treatment plan, and communicating further via digital means.
This CPT code represents a qualified nonphysician healthcare professional's online digital assessment and management service for an established patient.The service includes a cumulative time of 11-20 minutes spent over a seven-day period. This time encompasses reviewing the patient's initial inquiry, pertinent records, interacting with clinical staff, developing a management plan (including prescriptions or test orders), and subsequent digital communication with the patient.All professionals in the same group practice contributing to the assessment contribute to the cumulative time.Adequate documentation is required.
Example 1: A patient with an established relationship with a nurse practitioner (NP) uses a secure messaging portal to describe worsening symptoms of previously diagnosed hypertension. The NP reviews the message, checks the patient's medical records, adjusts the medication dosage, and communicates this change to the patient. The total time spent on this 7-day period is approximately 15 minutes., An established patient contacts their physician's office via a secure portal to discuss persistent back pain. The NP reviews the patient's history, performs a brief virtual examination using the portal and recommends physical therapy and appropriate over-the-counter pain relief measures, documenting the encounter and managing the patient's care.Time spent: 18 minutes., A patient uses a secure app to ask questions about their diabetes management.The certified nurse practitioner reviews the patient's records, answers the patient's questions about medication management, arranges a follow up appointment, and documents the encounter.Time spent: 12 minutes.
Detailed documentation of the online encounter is required and must include the patient's initial inquiry, the NP's review of the records, details of the assessment and management plan, all communication with the patient, and the total time spent on the encounter over the 7-day period. This documentation should be stored electronically or as a hard copy.
** Always refer to the most current CPT codebook and payer guidelines for the most up-to-date information on coding and reimbursement for this service.
- Revenue Code: M5D (Specialist - Other)
- RVU: Data unavailable.Consult the AMA CPT codebook or your payer for RVU information.
- Global Days: The service covers a 7-day period.If the patient presents a new, unrelated problem during this 7-day period, the time spent assessing the additional problem is added to the cumulative service time.
- Payment Status: Active
- Modifier TC rule: Not applicable. This is a complete service.
- Fee Schedule: Data unavailable.Consult the AMA CPT codebook or your payer for historical fee schedule data.
- Specialties:Family Medicine, Internal Medicine, Cardiology, Geriatrics, and other specialties where online digital patient assessment and management is relevant.
- Place of Service:Office, Telehealth Provided in Patient’s Home, Telehealth Provided Other than in Patient’s Home