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The CPT® Code 98967 refers to a telephone assessment and management service that is conducted by a nonphysician qualified health care professional for an established patient, parent, or guardian. This service is initiated by the patient or their representative and involves a medical discussion lasting between 11 to 20 minutes. It is important to note that this telephone service must not be related to any assessment and management service that occurred within the previous 7 days, nor should it lead to any subsequent assessment and management service or procedure within the next 24 hours or the soonest available appointment. Additionally, the service should not be performed during the post-operative period of a related surgical procedure. During the call, the nonphysician qualified health care professional, which may include roles such as a registered dietician, physical therapist, occupational therapist, or speech-language pathologist, engages with the patient to address their concerns, provide necessary counseling, and potentially modify the treatment plan based on the discussion. The details of the conversation, including the time spent, must be documented in the patient's medical record to ensure proper tracking and continuity of care.
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The telephone assessment and management service represented by CPT® Code 98967 is indicated for established patients, parents, or guardians who require a nonphysician qualified health care professional's input without the need for an in-person visit. This service is appropriate when the patient has specific complaints or concerns that can be addressed through a telephone conversation, and it is essential that this interaction does not stem from a related assessment and management service within the past week. Furthermore, it is indicated when the conversation does not lead to a subsequent face-to-face assessment or management service within the next 24 hours or the soonest available appointment. This service is particularly useful for ongoing management of chronic conditions or for providing guidance and support in a timely manner without necessitating an immediate office visit.
The procedure for CPT® Code 98967 involves several key steps that ensure a comprehensive telephone assessment and management service. First, the established patient, parent, or guardian initiates the call, expressing their concerns or questions. The nonphysician qualified health care professional then engages in a detailed discussion, actively listening to the patient's complaints and gathering relevant information. This step is crucial as it allows the professional to understand the context and specifics of the patient's situation. Following this, the professional provides appropriate counseling and instruction based on the information shared during the call. If necessary, the treatment plan may be modified to better suit the patient's current needs. Throughout the conversation, the professional documents the discussion in the medical record, noting the time spent on the call, which is essential for accurate billing and continuity of care. This structured approach ensures that the patient receives the necessary support and guidance while maintaining compliance with coding and billing regulations.
After the completion of the telephone assessment and management service, it is essential for the nonphysician qualified health care professional to ensure that the patient's concerns have been adequately addressed. The documentation of the call should be reviewed to confirm that all relevant information has been captured accurately. If any modifications to the treatment plan were made during the call, the professional should ensure that the patient understands the changes and any follow-up actions required. Additionally, the professional may need to schedule a follow-up appointment if the patient's condition warrants further evaluation or if the concerns raised during the call cannot be fully resolved through telephone communication. It is also important to remind the patient of the guidelines regarding the timing of any future assessments or management services, particularly in relation to the 24-hour rule following this telephone service.
| Short Descr | PH1 ASSMT&MGMT NQHP 11-20 | Medium Descr | TELEPHONE ASSMT&MGMT SVC NQHP EST PT 11-20 MIN | Long Descr | Telephone assessment and management service provided by a nonphysician qualified health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion | Status Code | Active Code | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Service Paid under Fee Schedule or Payment System other than OPPS | Type of Service (TOS) | 1 - Medical Care | Berenson-Eggers TOS (BETOS) | M5D - Specialist - other | MUE | 1 | CCS Clinical Classification | 237 - Ancillary Services |
| 95 | Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system: synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. modifier 95 may only be appended to the services listed in appendix p. appendix p is the list of cpt codes for services that are typically performed face-to-face, but may be rendered via a real-time (synchronous) interactive audio and video telecommunications system. | 25 | Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service: it may be necessary to indicate that on the day a procedure or service identified by a cpt code was performed, the patient's condition required a significant, separately identifiable e/m service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed. a significant, separately identifiable e/m service is defined or substantiated by documentation that satisfies the relevant criteria for the respective e/m service to be reported (see evaluation and management services guidelines for instructions on determining level of e/m service). the e/m service may be prompted by the symptom or condition for which the procedure and/or service was provided. as such, different diagnoses are not required for reporting of the e/m services on the same date. this circumstance may be reported by adding modifier 25 to the appropriate level of e/m service. note: this modifier is not used to report an e/m service that resulted in a decision to perform surgery. see modifier 57 for significant, separately identifiable non-e/m services, see modifier 59. | 93 | Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system : synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located away at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that is sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. | FQ | The service was furnished using audio-only communication technology | Q2 | Demonstration procedure/service | CR | Catastrophe/disaster related | GP | Services delivered under an outpatient physical therapy plan of care | AJ | Clinical social worker | X1 | Continuous/broad services: for reporting services by clinicians, who provide the principal care for a patient, with no planned endpoint of the relationship; services in this category represent comprehensive care, dealing with the entire scope of patient problems, either directly or in a care coordination role; reporting clinician service examples include, but are not limited to: primary care, and clinicians providing comprehensive care to patients in addition to specialty care | HO | Masters degree level | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | GW | Service not related to the hospice patient's terminal condition | 24 | Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period: the physician or other qualified health care professional may need to indicate that an evaluation and management service was performed during a postoperative period for a reason(s) unrelated to the original procedure. this circumstance may be reported by adding modifier 24 to the appropriate level of e/m service. | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 96 | Habilitative services: when a service or procedure that may be either habilitative or rehabilitative in nature is provided for habilitative purposes, the physician or other qualified health care professional may add modifier 96 to the service or procedure code to indicate that the service or procedure provided was a habilitative service. habilitative services help an individual learn skills and functioning for daily living that the individual has not yet developed, and then keep and/or improve those learned skills. habilitative services also help an individual keep, learn, or improve skills and functioning for daily living. | 97 | Rehabilitative services: when a service or procedure that may be either habilitative or rehabilitative in nature is provided for rehabilitative purposes, the physician or other qualified health care professional may add modifier 97 to the service or procedure code to indicate that the service or procedure provided was a rehabilitative service. rehabilitative services help an individual keep, get back, or improve skills and functioning for daily living that have been lost or impaired because the individual was sick, hurt, or disabled. | AH | Clinical psychologist | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | CO | Outpatient occupational therapy services furnished in whole or in part by an occupational therapy assistant | CQ | Outpatient physical therapy services furnished in whole or in part by a physical therapist assistant | CS | Cost-sharing waived for specified covid-19 testing-related services that result in and order for or administration of a covid-19 test and/or used for cost-sharing waived preventive services furnished via telehealth in rural health clinics and federally qualified health centers during the covid-19 public health emergency | FR | The supervising practitioner was present through two-way, audio/video communication technology | GA | Waiver of liability statement issued as required by payer policy, individual case | GC | This service has been performed in part by a resident under the direction of a teaching physician | GE | This service has been performed by a resident without the presence of a teaching physician under the primary care exception | GN | Services delivered under an outpatient speech language pathology plan of care | GO | Services delivered under an outpatient occupational therapy plan of care | GQ | Via asynchronous telecommunications system | GT | Via interactive audio and video telecommunication systems | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | HL | Intern | KX | Requirements specified in the medical policy have been met | PN | Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital | PO | Excepted service provided at an off-campus, outpatient, provider-based department of a hospital | Q0 | Investigational clinical service provided in a clinical research study that is in an approved clinical research study | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | SA | Nurse practitioner rendering service in collaboration with a physician | U3 | Medicaid level of care 3, as defined by each state | UA | Medicaid level of care 10, as defined by each state | UD | Medicaid level of care 13, as defined by each state | X4 | Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period |
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| 2025-01-01 | Changed | Short, Medium, and Long Descriptions changed. |
| 2013-01-01 | Changed | Guideline information changed. |
| 2009-01-01 | Changed | Code description changed. |
| 2008-01-01 | Added | First appearance in code book in 2008. |
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