2025 CPT code 99368
(Active) Effective Date: N/A Revision Date: N/A Evaluation and Management - Case Management Services Evaluation and Management Feed
Medical team conference; nonphysician qualified healthcare professional participation; 30 minutes or more; patient/family not present.
Modifier 25 may be applicable if a significant, separately identifiable E&M service was performed by the same provider on the same day. Other modifiers may apply depending on the circumstances.
Medical necessity is established when the patient's condition is complex and requires the coordinated expertise of multiple healthcare disciplines to develop and implement a comprehensive care plan.This is evident through documentation of the patient's multiple chronic conditions, and the individual assessments showing the need for this interdisciplinary approach.
The nonphysician qualified healthcare professional's clinical responsibility includes contributing their expertise to the development of a comprehensive treatment plan, based on their prior interaction and assessment of the patient. This contribution involves sharing their findings, recommendations, and coordinating care with other members of the healthcare team.
In simple words: A team of doctors and other healthcare professionals (like therapists or social workers) meet for at least 30 minutes to plan care for a patient. The patient and family aren't at this meeting.This code is used when a healthcare professional who is not a doctor takes part in the meeting.
This CPT code reports a medical team conference involving an interdisciplinary team of healthcare professionals, where a nonphysician qualified healthcare professional participates.The conference lasts 30 minutes or more, and neither the patient nor their family is present.The conference focuses on developing, revising, coordinating, and implementing healthcare services for a patient with complex needs requiring a multidisciplinary approach.Time spent on record-keeping and report generation is excluded.Only one provider from the same specialty can report this code per encounter. This code should not be reported if the participation is part of a facility or organizational service contractually provided.Prior face-to-face evaluations or treatments of the patient by the reporting participant within the preceding 60 days are required.The reported time cannot be used towards other services like care plan oversight, prolonged services, or psychotherapy.
Example 1: A physical therapist, occupational therapist, and a neurologist meet to discuss the rehabilitation plan for a patient recovering from a stroke, who also has diabetes requiring management by an endocrinologist. The physical therapist, as a nonphysician qualified healthcare professional, documents their participation in the 45-minute team conference using 99368., A social worker, dietician, and a nephrologist convene to discuss the care plan of a patient with end-stage renal disease and complex social and dietary needs. The social worker contributes information regarding the patient's support system and home environment to the 35-minute team meeting and uses 99368., A speech-language pathologist, respiratory therapist, and a pulmonologist meet to discuss the long-term care plan for a patient with severe chronic obstructive pulmonary disease and difficulty communicating. The speech-language pathologist documents their 50-minute involvement and reports 99368.
* Detailed notes from the team conference including time spent, participants, patient's diagnosis and history, and agreed-upon care plan.* Documentation of each participant's individual assessment of the patient (conducted within 60 days prior)* Evidence of the patient's complex health condition requiring a team approach.* Verification of the nonphysician qualified healthcare professional's involvement and contribution to the care plan.
** This code is for situations where the patient and/or family are not present at the conference. If the patient is present, code 99366 is used instead.The 30-minute minimum applies to the total time spent in the conference by the reporting provider, not necessarily continuous communication.
- Revenue Code: M5D (Specialist - Other)
- RVU: Information not available in provided text.Consult the AMA CPT codebook or other relevant payer resources for RVU information.
- Global Days: Not applicable to this code.This code represents a distinct service and is not part of a global surgical package.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Fee Schedule: Information not available in the provided text.Consult historical fee schedules from relevant payers.
- Specialties:Multiple specialties as this code applies to interdisciplinary team conferences; examples include but are not limited to: physical therapy, occupational therapy, social work, dietetics, speech-language pathology, neurology, cardiology, nephrology, pulmonology, endocrinology.
- Place of Service:Office, Hospital, Inpatient, Outpatient, other relevant places of service where interdisciplinary team conferences are held.