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The CPT® Code 98971 refers to the online digital assessment and management services provided by a nonphysician qualified health care professional for an established patient. This service is characterized by a cumulative time of 11 to 20 minutes spent over a period of up to 7 days. The encounter is initiated by the patient through electronic communication methods such as email, an electronic health record (EHR) portal, or similar platforms. During this digital interaction, the qualified health care professional, which may include registered dieticians, physical therapists, occupational therapists, or speech-language pathologists, engages in a comprehensive evaluation of the patient's concerns and inquiries. The professional reviews the patient's initial communication, addresses any questions, examines the patient's medical records and relevant data, and may request additional information pertinent to the patient's condition. Furthermore, the professional may collaborate with clinical staff regarding the patient's issues, formulate a management or treatment plan, prescribe medications, order diagnostic tests, and provide necessary counseling and instructions through digital means. It is important to note that the online service must be documented and stored in the patient's medical record, ensuring a clear record of the digital encounter. The service is specifically designed for new inquiries that are not related to any postoperative or previous assessment and management services conducted within the last seven days. The time spent on the digital encounter is reported cumulatively, with specific codes assigned for varying durations of service: CPT® Code 98970 for 5-10 minutes, CPT® Code 98971 for 11-20 minutes, and CPT® Code 98972 for 21 or more minutes.
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The CPT® Code 98971 is indicated for use when an established patient requires online digital assessment and management services. This service is appropriate for patients who have specific inquiries or concerns that necessitate evaluation and management by a nonphysician qualified health care professional. The indications for this service include, but are not limited to, the following:
The procedure associated with CPT® Code 98971 involves several key steps that ensure a thorough digital assessment and management process. Each step is crucial for delivering effective care to the patient.
After the completion of the digital assessment and management service, the patient may expect to receive follow-up instructions based on the management plan developed during the encounter. The qualified health care professional may advise the patient on any necessary next steps, such as scheduling further appointments, adhering to prescribed treatments, or making lifestyle adjustments. Additionally, the documentation of the encounter will be stored in the patient's medical record, providing a comprehensive account of the digital interaction for future reference. It is important for the patient to monitor their condition and reach out to the health care professional if new concerns arise or if there are any changes in their health status.
| Short Descr | NQHP OL DIG ASSMT&MGMT 11-20 | Medium Descr | NQHP OL DIGITAL ASSMT&MGMT EST PT <7 D 11-20 MIN | Long Descr | Nonphysician qualified health care professional online digital assessment and management, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes | 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 | Berenson-Eggers TOS (BETOS) | none | MUE | 1 |
| 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. | GA | Waiver of liability statement issued as required by payer policy, individual case | GP | Services delivered under an outpatient physical therapy plan of care | 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. | 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. | AT | Acute treatment (this modifier should be used when reporting service 98940, 98941, 98942) | CQ | Outpatient physical therapy services furnished in whole or in part by a physical therapist assistant | GN | Services delivered under an outpatient speech language pathology plan of care | GO | Services delivered under an outpatient occupational therapy plan of care | GW | Service not related to the hospice patient's terminal condition | 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 | KX | Requirements specified in the medical policy have been met | SW | Services provided by a certified diabetic educator |
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| 2025-01-01 | Changed | Short, Medium, and Long Descriptions changed. |
| 2020-07-01 | Changed | Description changed per CPT Errata. |
| 2020-01-01 | Added | Code added. |
| 2020-01-01 | Changed | Code description changed. |
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