2025 CPT code 98972
(Active) Effective Date: N/A Revision Date: N/A Online Digital Assessment and Management - Non-Face-to-Face Nonphysician Services Medicine Services and Procedures Feed
Qualified nonphysician healthcare professional online digital assessment and management service for an established patient; 21 or more minutes of cumulative time during a 7-day period.
Modifiers may be applicable depending on the circumstances of the service.For instance, modifier 24 might apply if the service is unrelated to a recent E/M service within the same seven-day period. Consult the official CPT guidelines and your payer's specific policies.
Medical necessity for this service would be established by the patient presenting with an established medical condition that requires online management or assessment by a qualified nonphysician healthcare provider. The service must be deemed clinically appropriate, given the patient's condition and the provider's clinical judgment.
The qualified nonphysician healthcare professional is responsible for assessing the patient's condition, developing a management plan, providing instructions and education, ordering tests, writing prescriptions when appropriate, and documenting the entire interaction in the patient's medical record.
- Medicine Services and Procedures
- Medicine Services and Procedures > Non-Face-to-Face Nonphysician Services
In simple words: This code covers a healthcare professional (like a nurse practitioner) who spends 21 minutes or more over 7 days communicating online with a returning patient about their health issue, creating a treatment plan, and following up.This includes messaging, phone calls, and sending prescriptions or orders for tests.
This CPT code reports online digital assessment and management services provided by a qualified nonphysician healthcare professional to an established patient.The service encompasses a cumulative time of 21 or more minutes over a 7-day period, starting from the initial review of the patient's inquiry.This cumulative time includes reviewing the initial inquiry, relevant patient records, interaction with clinical staff, developing management plans (including prescriptions or test orders), and subsequent communication with the patient via online, phone, email, or other digital means.All qualified nonphysician healthcare professionals in the same group practice contributing to the assessment contribute to the cumulative time.Adequate documentation and permanent storage of the encounter are required.
Example 1: A nurse practitioner uses a secure patient portal to communicate with an established patient experiencing worsening asthma symptoms.The NP spends 25 minutes over three days reviewing the patient's history, communicating with the patient, adjusting their medication regimen, and providing educational materials. Code 98972 is appropriate., A physician assistant (PA) communicates with an established patient through email to address concerns about a recent prescription.The PA spends several days responding to questions, clarifying instructions, and offering advice related to medication management. Over 7 days, the cumulative time exceeds 21 minutes. Code 98972 is reported., A clinical nurse specialist (CNS) uses a telehealth platform to counsel an established patient with chronic pain management. The CNS reviews the patient’s pain diary over 7 days and provides online counseling, spends over 21 minutes cumulative time and adjusts the patient’s pain management plan. Code 98972 is used.
Comprehensive documentation is required, including the initial patient inquiry, the nonphysician provider's responses and plan of care, any prescriptions or orders for tests, and all communication with the patient (date, time, method of communication, and content). The cumulative time spent should also be meticulously documented.
** Payer policies may vary. Always consult your specific payer's guidelines to ensure proper reimbursement for this service.Accurate documentation and clear adherence to the cumulative time guidelines are critical for appropriate billing.
- Revenue Code: M5D (SPECIALIST - OTHER)
- RVU: RVUs are not specified in the provided text.Consult the current CPT manual or your payer's fee schedule for the most up-to-date RVU values.
- Global Days: The global period is implicitly defined as 7 days, starting from the initial review of the online inquiry.No additional services related to the same problem can be billed during this 7-day period.
- Payment Status: Active
- Modifier TC rule: A technical component (TC) modifier is not applicable to this code as it represents the entire professional service.
- Fee Schedule: Historical fee schedule data is not provided. Consult your payer's historical fee schedules for relevant information.
- Specialties:Nurse Practitioner, Physician Assistant, Clinical Nurse Specialist
- Place of Service:Office, Telehealth Provided in Patient’s Home, Telehealth Provided Other than in Patient’s Home