CPT 98966 Telephone Visit Reimbursement & Policy

Headline: CPT code 98966: Short Telephone Assessment by Nonphysician Clinician

Lead: CPT code 98966 identifies a brief telephone encounter—five to ten minutes—during which a nonphysician qualified healthcare professional discusses a patient’s health issue and possible treatment or management with an established patient, parent, or guardian. The code captures a common remote communication modality that affects access, workflow, and claims processing nationally.

What the code represents and why it matters: CPT code 98966 covers short, telephone-based clinical discussions by nonphysician clinicians. As payers and practices continue to incorporate telecommunication services, this code is important for documenting and remunerating brief remote clinical interactions that fall outside traditional in-person visits.

Key payers covered: Analysis covers major national payers including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

What readers will learn: The publication provides benchmarks for utilization and reimbursement, outlines common billing practice considerations, and summarizes the clinical context in which brief telephone encounters are used. It also highlights coding boundaries for nonphysician-delivered telephone services and the typical service setting.

Data limitations: Data not available in the input for associated taxonomies, ICD-10 codes, and related codes.

Billing Code Overview

CPT code 98966 describes a telephone encounter in which a nonphysician qualified healthcare professional discusses a health issue and possible treatment or management with an established patient, parent, or guardian. The service specifically includes five to ten minutes of medical discussion.

Service Type: Telephone assessment and management by a nonphysician clinician

Typical Site of Service: Non-face-to-face/telecommunication setting (telephone)

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.

Coding Specifications

Modifier	Description	When to Use
`95`	Synchronous telemedicine service rendered via real-time interactive audio and video	Use when the service is rendered via teleconference meeting that meets payor telehealth requirements (note: `98966` describes telephone-only; use cautiously per payor rules).

Taxonomy Code	Specialty	Notes
`163W00000X`	Family Medicine	Common provider taxonomy for primary care clinicians overseeing or delegating telephone triage and management.
`363L00000X`	Nurse Practitioner	Nonphysician qualified health professionals, including NPs, commonly deliver telephone management services described by `98966`.
`367A00000X`	Physician Assistant	PAs frequently provide telephonic patient counseling and management under supervising physician arrangements.
`174400000X`	Internal Medicine	Internal medicine clinicians and their teams commonly manage established adult patients via telephone.
`207Q00000X`	Emergency Medicine	Triage nurses and advanced practice clinicians in emergency departments may provide brief telephone follow-up or triage calls consistent with this code.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
Data not available in the input.	Data not available in the input.	Data not available in the input.

Related CPT Codes

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

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Summary & Overview

CPT 98966: Telephone Assessment by Nonphysician Clinician, 5–10 Minutes