2025 CPT code 99367
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Evaluation and Management - Case Management Services Evaluation and Management Feed
Medical team conference; physician participation; 30 minutes or more; patient and/or family not present.
Modifiers may apply depending on the circumstances. Consult your payer's guidelines for appropriate modifier use.
The medical necessity is established by the complexity of the patient's condition requiring coordinated care from multiple specialists.Documentation must support the need for a multidisciplinary team conference to optimize the patient's care plan and improve outcomes.The complexity should justify the time spent.
The physician's responsibility includes participation in the multidisciplinary discussion of the patient's care plan, contributing their expertise and making recommendations based on their evaluation of the patient's condition and treatment options. This does not include direct patient care during the conference.
In simple words: Doctors from different medical fields meet for at least 30 minutes to discuss a patient's treatment plan without the patient or family present.This code is for the doctor's time spent in the meeting.
This CPT code reports a medical team conference involving an interdisciplinary team of healthcare professionals.The conference lasts 30 minutes or more, and neither the patient nor their family is present.The code is specifically for physician participation in such a conference. Time spent on record-keeping or report generation is excluded.Only one physician from the same specialty can report this code for a single encounter.This code is not reportable if participation is part of a facility or organizational service contract.
Example 1: A patient with complex medical needs (e.g., diabetes, hypertension, and congestive heart failure) requires the coordinated care of a cardiologist, endocrinologist, and nephrologist. The physicians meet for 45 minutes to discuss the patient's treatment plan, care coordination, and medication management. The patient and family are not involved in this meeting.Code 99367 is appropriate for each physician's participation., A multidisciplinary team consisting of a surgeon, oncologist, and radiologist discuss the treatment plan for a patient diagnosed with a rare type of cancer. This discussion, lasting 60 minutes, determines the best course of treatment. The patient and family were not present at the conference. Code 99367 is used to bill for the participating physician’s time., A hospitalist and a pulmonologist consult on a complex case involving a patient who has been admitted to the hospital for acute respiratory distress syndrome.They spent 35 minutes discussing the patient's history, current condition, treatment strategy, and possible complications. The patient and family were not present.99367 is used to bill each participating physician.
Detailed notes documenting the patient's condition, relevant medical history, diagnostic findings, treatment recommendations from each participating specialist, and the overall plan of care developed during the conference.The documentation must also verify the duration of the meeting and the involvement of at least three professionals from different specialties.
** This code should only be reported by the physician who directly participated in the conference.Documentation should clearly show the roles of each participant and justify the time spent. Be aware that many payers have specific policies concerning reimbursement for this code.Always verify your payer’s specific requirements.
- Revenue Code: M1B (Office Visits - Established)
- RVU: Refer to the AMA's CPT codebook or your payer's fee schedule for RVU values. Note that CMS considers these codes bundled and may not use RVUs for payment.
- Global Days: Not applicable.This code does not have a global period.
- Payment Status: Active, but reimbursement may vary by payer. CMS considers this code bundled.
- Modifier TC rule: Not applicable. This is not a procedure with a technical component.
- Fee Schedule: Fee schedule data varies by payer and year.Consult historical fee schedules from your payer for specific reimbursement amounts.
- Specialties:Multiple specialties, including but not limited to Cardiology, Oncology, Pulmonology, Endocrinology, Nephrology, Surgery, and Radiology.
- Place of Service:Office, Hospital Inpatient, Hospital Outpatient, Ambulatory Surgical Center