CPT 98970 Reimbursement Benchmarks & Policy | OpenPayer

Summary & Overview

CPT 98970: Online Digital Assessment and Management Service

CPT 98970 designates an online digital assessment and management service delivered by qualified nonphysician health care professionals for established patients over a cumulative seven-day period. It formalizes asynchronous or longitudinal digital interactions that do not require an in-person encounter, supporting care continuity and remote management for conditions commonly addressed by behavioral health and rehabilitation clinicians. Nationally, this code matters because it clarifies a billing pathway for nonphysician providers who deliver remote, time-based digital services outside of traditional visits.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the service definition, common clinical contexts, associated billing considerations, and related CPT references that clarify telehealth-adjacent nonphysician digital services. The publication highlights where this code fits within the suite of nonphysician telephonic and digital codes, typical site of service, and common modifiers used in practice (presented elsewhere in the document). It also outlines typical clinical diagnoses that align with use of this service and comparable CPT codes for telephone and digital assessment to aid coding and billing alignment. Data not provided in the input, such as payer-specific reimbursement rates or local coverage determinations, is noted as unavailable.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareCPT 98970Non-Face-to-Face ServicesDigital HealthTelehealthNonphysician ProvidersBehavioral HealthRehabilitationBilling Guidance

CPT Code Overview

CPT 98970 describes an online digital assessment and management service provided by a qualified nonphysician health care professional for an established patient covering up to seven days of cumulative time during that period. This service is a form of non–face-to-face nonphysician care delivered remotely through digital platforms rather than an in-person visit. The typical site of service is Office (POS 11).

Clinical & Coding Specifications

Clinical Context

A 38-year-old established patient with a history of generalized anxiety disorder (F41.1) and episodic major depressive disorder (F32.9) sends an online message through the health system’s secure portal describing worsening anxiety, difficulty sleeping, and increased fatigue. A licensed clinical social worker (LCSW) reviews the patient’s chart, assesses symptoms via the portal, documents clinical decision-making, provides brief therapeutic guidance, adjusts plan of care, and coordinates follow-up over a cumulative 7-day period totaling the documented time for digital interactions. The service is non–face-to-face and provided by a qualified nonphysician health care professional in the office setting (POS 11).

Coding Specifications

Modifier 95:

Use when the service is delivered as a synchronous telemedicine visit via real-time audio and video telecommunications.

Modifier GT:

Use when the service is provided via interactive audio and video telecommunication systems (telehealth).

Associated provider taxonomies:

1041C0700X — Clinical Social Worker
101YM0800X — Mental Health Counselor

National Reimbursement Benchmarks

National mean allowed rates for CPT 98970 place Medicare near the lower end of the commercial spectrum: the Medicare mean of $12.72 is modestly below the BUCA (average commercial) mean of $16.31. This reflects Medicare reimbursement clustering tightly around the low $12–$13 range while commercial payers generally pay higher mean amounts.

Dispersion measured as the difference between the 75th and 25th percentiles varies across payers. Blue Cross Blue Shield and UnitedHealth Group show wider spreads (BCBS: $8.00 range, UHC: $9.50 range), indicating greater rate variability, while Medicare is the tightest with a $1.00 range. Aetna and BUCA are relatively tight (Aetna: $2.00, BUCA: $7.50), and Cigna shows a moderate-to-wide spread of $8.50. The table and chart below present the full breakdown.

State Benchmarks

State: Alaska1 / 50

Alaska Benchmarks

Alaska exhibits a notably wide rate spread for CPT code 98970, particularly among commercial payers. Blue Cross Blue Shield shows the largest spread, with a 75th percentile rate of $47.00 and a 25th percentile rate of $31.13, resulting in a $15.87 difference. UnitedHealth Group and BUCA also display substantial spreads, while Aetna's rates are tightly clustered, with all percentiles at $26.00. This indicates limited variability for Aetna, but significant variation for other payers.

Compared to national averages, Alaska's commercial payers consistently reimburse at much higher rates. For example, Blue Cross Blue Shield's mean rate in Alaska is more than double its national mean. Medicare rates in Alaska are closely aligned with national benchmarks, showing minimal deviation. The table and chart below present the full breakdown of payer rates in Alaska for CPT code 98970.

Key Insights for Alaska

Blue Cross Blue Shield is the highest paying payer for CPT 98970 in Alaska, with a mean rate of $37.89.
Medicare is the lowest paying payer, with a mean rate of $12.53, closely aligned with the national Medicare average.
All commercial payers in Alaska reimburse at significantly higher rates than their respective national averages, with Blue Cross Blue Shield and UnitedHealth Group showing the largest deviations.

CPT 98972: Online Digital Evaluation and Management for Established Patients

98971-QUALIFIED-NONPHYSICIAN-HEALTH-CARE-PROFESSIONAL-ONLINE

CPT 98971: Online Digital E/M for Established Patients, 11–20 Minutes

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

National Reimbursement Benchmarks

National Mean Allowed Rates for CPT `98970` by Payer

State Benchmarks

State: Alaska1 / 50

Alaska Benchmarks

Mean CPT 98970 Rates by Payer in Alaska

Key Insights for Alaska

Blue Cross Blue Shield is the highest paying payer for CPT 98970 in Alaska, with a mean rate of $37.89.
Medicare is the lowest paying payer, with a mean rate of $12.53, closely aligned with the national Medicare average.
All commercial payers in Alaska reimburse at significantly higher rates than their respective national averages, with Blue Cross Blue Shield and UnitedHealth Group showing the largest deviations.

CPT 98972: Online Digital Evaluation and Management for Established Patients

98971-QUALIFIED-NONPHYSICIAN-HEALTH-CARE-PROFESSIONAL-ONLINE

CPT 98971: Online Digital E/M for Established Patients, 11–20 Minutes

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Summary & Overview

CPT 98970: Online Digital Assessment and Management Service

CPT Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

National Reimbursement Benchmarks

State Benchmarks

Alaska Benchmarks

Key Insights for Alaska

Related Codes

Related Diagnoses

Related CPT Codes

National Reimbursement Benchmarks

State Benchmarks

Alaska Benchmarks

Key Insights for Alaska

Related Codes