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    v1.0.28
    OpenPayerBilling CodesNon-Face-to-Face Nonphysician Telephone ServicesCPT cpt-98966-telephone-nonphysician-established-patient-5-10-minutes
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    CPT 98966: Nonphysician Telephone Evaluation, 5-10 Minutes

    Medicare pays $14 on average nationally for this procedure.

    CPT code 98966 describes a telephone evaluation and management service provided by a nonphysician qualified healthcare professional to an established patient, parent, or guardian involving a focused medical discussion of a health issue and possible treatment or management; service type: telephone/telephonic consultation; typical site of service: non-face-to-face (telehealth/remote) setting, five to ten minutes of medical discussion.

    For related coverage guidance, see recent payer policy updates: Lumbar Microdiscectomy, Artificial Cervical Intervertebral Disc, Lumbar Decompression.

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    Clinical & Coding Specifications

    Clinical Context

    A patient established with a primary care clinic calls reporting a worsening cough and low-grade fever. A licensed practical nurse or other nonphysician qualified healthcare professional conducts a telephone encounter lasting seven minutes to assess symptoms, review current medications, and advise on symptomatic care and red-flag signs that require urgent in‑office or emergency evaluation. The workflow includes verifying patient identity, confirming the reason for the call, reviewing recent visits and current problem list in the electronic health record, documenting the clinical discussion, and, if needed, arranging follow-up by the supervising physician or scheduling an in‑person visit. The service is delivered remotely by telephone from the clinic or an approved telework location and is provided to an established patient, parent, or guardian. The interaction focuses on education, triage, and management options without a face‑to‑face examination and fits the five to ten minute time frame described by 98966.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    98966Nonphysician telephone assessment and management, established patient, 5-10 minutes of medical discussionRepresents the billed service for a brief telephone encounter by a nonphysician qualified healthcare professional.
    98967Nonphysician telephone assessment and management, established patient, 11-20 minutes of medical discussionUsed when the telephone discussion extends beyond the 5-10 minute range and requires a longer time-based code.
    98968Nonphysician telephone assessment and management, established patient, 21-30 minutes of medical discussionApplied when the telephone encounter meets the time thresholds for a longer nonphysician telephonic service.
    99441Physician telephone evaluation and management service by a physician, 5-10 minutes of medical discussionPhysician-level counterpart for brief telephone E/M services when a physician rather than a nonphysician provides the call.
    99442Physician telephone evaluation and management service, 11-20 minutesUse when a physician provides a longer telephone E/M encounter that exceeds 99441 time.
    99443Physician telephone evaluation and management service, 21-30 minutesUse for physician telephone encounters meeting this longer time threshold.

    Related Modifiers

    5 rows

    ModifierDescriptionWhen to Use
    95Modifier 95 indicates that a service was provided via synchronous, real‑time audio‑video telehealth rather than in‑person. Per CMS, AAPC and professional associations, append modifier 95 to claim…- Use modifier 95 to indicate a service was furnished via synchronous, real‑time audiovisual telehealth (a live audio‑video conference between patient and provider) rather than in‑person. - Pair…
    93Modifier 93 denotes that a billed service was delivered synchronously via audio-only telecommunications (real-time telephone or other audio-only system). The AMA added modifier 93 in CPT Appendix A…- When to use: Apply modifier -93 when a synchronous, real-time, two-way patient–provider encounter is conducted entirely via audio-only (telephone or other real-time interactive audio-only…
    25CPT modifier 25 indicates that on the same day as another procedure or service, the same physician or other qualified health care professional provided a significant, separately identifiable…- When to apply: Use modifier 25 only on an E/M code to indicate the same provider delivered a significant, separately identifiable E/M service on the same day as another procedure or service — i.e.,…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    163W00000XRegistered Nurse(1) A registered nurse is a person qualified by graduation from an accredited nursing school (depending upon schooling, a registered nurse may receive…
    363L00000XNurse Practitioner(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision mak…
    367A00000XAdvanced Practice MidwifeAdvanced practice midwifery encompasses the independent provision of care during pregnancy, childbirth, and the postpartum period; sexual and reproduc…
    174400000XSpecialistAn individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond…
    207Q00000XFamily Medicine PhysicianFamily Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadt…
    347E00000XTransportation BrokerAn organization that provides transportation for individuals who need access to medical care or services and have no other means of transportation. Tr…
    261QF0400XFederally Qualified Health Center (FQHC)Ambulatory Health Care Facilities · Clinic/Center
    163WN0002XNeonatal Intensive Care Registered NurseNursing Service Providers · Registered Nurse

    Related Payer Policy Updates

    Specialty: Neurology/Neurosurgery1 / 3

    10 rows

    PolicyPayerEffective Date
    Lumbar Microdiscectomyuniverahealthcare2026-10-15
    Artificial Cervical Intervertebral Discuniverahealthcare2026-10-15
    Lumbar Decompressionuniverahealthcare2026-10-15
    Nerve Fiber Density Testing (IENFD/ENFD) Coverage CriteriaOscar Health2026-10-01
    Biomarker Testing for Multiple Sclerosis and Related Neurologic DiseasesOscar Health2026-10-01
    Biochemical Markers of Alzheimer Disease and DementiaOscar Health2026-10-01
    Serum Testing For Evidence of Mild Traumatic Brain InjuryOscar Health2026-10-01
    Evaluation of Cerebrospinal Fluid, Urine and Plasma for Alzheimer DiseaseBluecross Idaho2026-09-01
    Prior Authorization of Spinal ProceduresBlue Cross Blue Shield - Rhode Island2026-09-01
    Alzheimer's Disease - Amyloid Beta- Directed Antibodies - KisunlaCigna2026-08-15

    Related Codes

    CPT-98967-TELEPHONIC-NONPHYSICIAN-CONSULTATION-11-20-MINUTES

    CPT 98967: Telephone Medical Discussion by Nonphysician (11–20 min)

    CPT-98968-NONPHYSICIAN-TELEPHONE-EVALUATION-21-30-MINUTES

    CPT 98968: Telephone Discussion by Nonphysician, 21-30 Minutes

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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