CPT® Code 98968 is used to report telephone assessment and management services provided by a qualified nonphysician healthcare professional to an established patient, lasting 21 to 30 minutes. These services involve clinical evaluation, management decisions, and patient counseling conducted over the phone when an in-person or telehealth visit is not required.
This code applies to clinical staff such as nurses, therapists, or other qualified healthcare professionals operating within their scope of practice.
Key Facts About CPT® 98968
Service type: Telephone assessment and management service
Provider type: Qualified nonphysician healthcare professionals (e.g., nurses, therapists, clinical staff)
Medical services included: Yes—clinical assessment, management, and counseling by phone
Time requirement: 21 to 30 minutes of medical discussion
Patient type: Established patients only
Common clinical indications:
- Follow-up discussions regarding treatment plans or symptoms
- Medication management and monitoring
- Review of test results and clinical recommendations
- Chronic disease management support
- Patient education and counseling related to ongoing care
When to Use CPT® 98968
CPT 98968 is appropriate when:
- A qualified nonphysician healthcare professional provides a telephone assessment lasting 21 to 30 minutes
- The patient is established with the practice
- The discussion involves clinical evaluation and management
- The service is not related to a recent E/M visit (within the previous 7 days)
- The call does not result in an in-person or telehealth visit within the next 24 hours or soonest available appointment
Examples:
- A nurse spends 25 minutes reviewing symptoms and adjusting care instructions for a chronic condition
- A therapist provides extended telephone counseling to support ongoing treatment
- Clinical staff conduct a detailed follow-up discussion after reviewing laboratory results
- Providing patient education and care plan adjustments during a scheduled telephone follow-up
Documentation Requirements
To support CPT 98968 billing, documentation should include:
- Patient identifiers and date of service
- Name and credentials of the nonphysician healthcare professional
- Total time spent on the telephone (21–30 minutes)
- Clinical issues discussed and assessment performed
- Management recommendations or care plan changes
- Confirmation that the patient is established
- Provider signature and credentials
Accurate documentation supports compliance, reimbursement, and continuity of patient care.
Reimbursement and Coding Considerations
- CPT 98968 applies only to nonphysician healthcare professionals
- The service must be provided to an established patient
- Time must total 21 to 30 minutes of medical discussion
- The service cannot be billed if related to an E/M visit within the previous 7 days
- The service cannot be billed if it results in an in-person or telehealth visit within 24 hours or the next available appointment
- Verify payer-specific reimbursement policies for telephone services
Proper coding ensures compliance and appropriate reimbursement for telephone-based clinical care.
How OptiMantra Supports Telephone Assessment Services
OptiMantra’s integrated EMR and practice management system simplifies documentation and billing for CPT 98968:
With OptiMantra, providers can:
- Document telephone encounters with accurate time tracking
- Record clinical assessments, counseling, and care plan updates
- Link telephone services to diagnoses and ongoing treatment plans
- Support accurate CPT and ICD-10 code selection for compliant telephone encounter billing
- Maintain complete communication records within the patient’s longitudinal health record
By centralizing telephone encounter documentation and billing, OptiMantra helps practices improve efficiency, maintain compliance, and optimize reimbursement.
Try OptiMantra for free here!
Disclaimer: CPT® codes are maintained by the American Medical Association. This guide is for informational purposes only and does not replace official coding guidelines or payer policies.
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