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The CPT® Code 98972 refers to a specific type of online digital assessment and management service provided by a nonphysician qualified health care professional for an established patient. This service is characterized by a cumulative time of 21 or more 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 digital platforms. During this 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 process involves reviewing the patient's initial communication, addressing their complaints, and answering any questions they may have. The professional also examines the patient's medical records and other relevant data, requests additional information if necessary, and may collaborate with clinical staff regarding the patient's issues. Based on this assessment, the qualified professional develops a management or treatment plan, which may include writing prescriptions or ordering tests, as well as providing counseling and instructions to the patient. All interactions and decisions made during this digital service are documented and stored in the patient's medical record. It is important to note that the digital encounter must begin with a review of a new inquiry that is not related to any postoperative or previous assessment and management service conducted within the last seven days. The time spent on the digital service is cumulative and is reported according to the specific time intervals outlined in the CPT® coding guidelines.
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The CPT® Code 98972 is indicated for use when an established patient requires online digital assessment and management services provided by a nonphysician qualified health care professional. This service is appropriate for patients who have specific complaints or concerns that can be addressed through electronic communication. The following conditions may warrant the use of this code:
The procedure associated with CPT® Code 98972 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 communication regarding their management plan. The qualified health care professional may provide additional instructions or recommendations based on the assessment. It is important for the patient to monitor their condition and reach out if new concerns arise or if there are questions about the management plan. The documentation of the encounter will be stored in the medical record, ensuring that all information is available for future reference and continuity of care. The cumulative time spent on the digital service is tracked and reported according to the specified time intervals, ensuring accurate coding and billing for the services rendered.
| Short Descr | NQHP OL DIG ASSMT&MGMT 21+ | Medium Descr | NQHP OL DIGITAL ASSMT&MGMT EST PT <7 D 21+ 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; 21 or more 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. | GO | Services delivered under an outpatient occupational therapy plan of care | GA | Waiver of liability statement issued as required by payer policy, individual case | 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. | AB | Audiology service furnished personally by an audiologist without a physician/npp order for non-acute hearing assessment unrelated to disequilibrium, or hearing aids, or examinations for the purpose of prescribing, fitting, or changing hearing aids; service may be performed once every 12 months, per beneficiary | 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 | CR | Catastrophe/disaster related | GN | Services delivered under an outpatient speech language pathology plan of care | GP | Services delivered under an outpatient physical 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 |
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| 2025-01-01 | Changed | Short, Medium, and Long Descriptions changed. |
| 2021-01-01 | Note | Guidelines 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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