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The CPT® Code 98968 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 characterized by a medical discussion lasting between 21 to 30 minutes. It is important to note that the telephone conversation 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. The professionals eligible to provide this service include registered dieticians, physical therapists, occupational therapists, and speech-language pathologists. During the call, the health care professional engages with the patient to address their concerns, provide necessary counseling, and potentially modify the treatment plan based on the discussion. Documentation of the conversation, including the time spent, is essential for record-keeping and billing purposes. This code is specifically designed to facilitate communication and management of patient care remotely, ensuring that patients receive appropriate guidance and support without the need for an in-person visit.
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The telephone assessment and management service represented by CPT® Code 98968 is indicated for established patients, parents, or guardians who require a medical discussion that does not stem from a related assessment and management service within the past week. This service is appropriate when the patient has concerns or questions that need to be addressed without necessitating an immediate face-to-face appointment. The indications for this service include:
The procedure for CPT® Code 98968 involves several key steps that ensure a comprehensive telephone assessment and management service. Each step is crucial for effective patient care and documentation.
After the telephone assessment and management service is completed, the patient may be advised on any follow-up actions or recommendations based on the discussion. The health care professional may suggest scheduling a follow-up appointment if further evaluation is needed or if the patient's condition does not improve. Additionally, the documentation created during the call serves as a reference for future interactions and ensures continuity of care. It is important for the patient to adhere to any instructions provided during the call and to reach out if new concerns arise or if their condition changes.
| Short Descr | PH1 ASSMT&MGMT NQHP 21-30 | Medium Descr | TELEPHONE ASSMT&MGMT SVC NQHP EST PT 21-30 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; 21-30 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. | CR | Catastrophe/disaster related | 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 | AJ | Clinical social worker | GP | Services delivered under an outpatient physical therapy plan of care | 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. | GT | Via interactive audio and video telecommunication systems | GQ | Via asynchronous telecommunications system | KX | Requirements specified in the medical policy have been met | Q2 | Demonstration procedure/service | U4 | Medicaid level of care 4, as defined by each state | GW | Service not related to the hospice patient's terminal condition | CQ | Outpatient physical therapy services furnished in whole or in part by a physical therapist assistant | HO | Masters degree level | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | GZ | Item or service expected to be denied as not reasonable and necessary | 22 | Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service. | 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. | 33 | Preventive services: when the primary purpose of the service is the delivery of an evidence based service in accordance with a us preventive services task force a or b rating in effect and other preventive services identified in preventive services mandates (legislative or regulatory), the service may be identified by adding 33 to the procedure. for separately reported services specifically identified as preventive, the modifier should not be used. | 57 | Decision for surgery: an evaluation and management service that resulted in the initial decision to perform the surgery may be identified by adding modifier 57 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. | 79 | Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.) | AH | Clinical psychologist | 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 | 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 | FS | Split (or shared) evaluation and management visit | 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 | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | 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 | HE | Mental health program | HI | Integrated mental health and intellectual disability/developmental disabilities program | HL | Intern | PD | Diagnostic or related non diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days | PN | Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | SA | Nurse practitioner rendering service in collaboration with a physician | U1 | Medicaid level of care 1, as defined by each state | U3 | Medicaid level of care 3, as defined by each state | UA | Medicaid level of care 10, as defined by each state | 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 | 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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Notes
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| 2025-01-01 | Changed | Short, Medium, and Long Descriptions changed. |
| 2022-01-01 | Note | Guidelines changed. |
| 2021-01-01 | Note | Guidelines 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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