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    v1.0.28
    OpenPayerBilling CodesNon-Face-to-Face Nonphysician Telephone ServicesCPT cpt-98967-telephonic-nonphysician-consultation-11-20-minutes
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    CPT 98967: Telephone Medical Discussion by Nonphysician (11–20 min)

    Medicare pays $26 on average nationally for this procedure.

    CPT code 98967 describes a nonphysician qualified health care professional providing a telephone discussion with an established patient, parent, or guardian about a health issue and options for treatment or management; the service represents 11 to 20 minutes of medical discussion and is a telephonic evaluation and management service typically delivered as telehealth/telephone care rather than an in-person visit.

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

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    Table of contents

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    Clinical & Coding Specifications

    Clinical Context

    An established adult patient with a history of hypertension calls the clinic reporting increased home blood pressures and intermittent headaches. A licensed practical nurse or a physician assistant conducts a telephone encounter lasting 15 minutes to review recent readings, medication adherence, side effects, and to recommend nonprocedural adjustments such as reinforcing salt restriction and suggesting an office blood pressure check. The clinician documents the time spent, the medical discussion topics, assessment, and follow-up plan in the electronic medical record. The service is billed using 98967 for a nonphysician qualified healthcare professional providing 11–20 minutes of medical discussion by telephone. Typical site of service is the outpatient clinic or ambulatory care setting (telephone-based remote communication). This workflow often includes triage, focused history review, medication reconciliation, patient education, and scheduling of in-person follow-up if indicated.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    99441Telephone evaluation and management service by a physician or other qualified healthcare professional, 5–10 minutes of medical discussionShorter-duration physician telephone service; used when physician provides brief telephonic management instead of nonphysician 98967.
    99442Telephone evaluation and management service by a physician or other qualified healthcare professional, 11–20 minutes of medical discussionPhysician-level telephone service comparable in time to 98967; used when physician (not nonphysician) conducts the 11–20 minute call.
    99443Telephone evaluation and management service by a physician or other qualified healthcare professional, 21–30 minutes of medical discussionLonger telephone management when the conversation exceeds the 11–20 minute window of 98967.
    98966Nonphysician qualified health care professional telephone assessment and management service, 5–10 minutes of medical discussionUsed for shorter nonphysician telephone encounters; precedes or replaces 98967 for briefer calls.
    99421Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5–10 minutesAsynchronous digital service that may be used instead of a telephone call when communication occurs over secure messaging.

    Related Modifiers

    6 rows

    ModifierDescriptionWhen to Use
    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.,…
    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…
    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…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    24Modifier 24 denotes an unrelated evaluation and management (E/M) service performed by the same physician or qualified healthcare professional during a postoperative global period. Per CPT guidance,…- Use modifier 24 when you report an evaluation and management (E/M) service performed by the same physician or same-specialty group during a procedure’s postoperative global period that is unrelated…

    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…
    363A00000XPhysician AssistantA physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and…
    367A00000XAdvanced Practice MidwifeAdvanced practice midwifery encompasses the independent provision of care during pregnancy, childbirth, and the postpartum period; sexual and reproduc…
    207L00000XAnesthesiology PhysicianAn anesthesiologist is trained to provide pain relief and maintenance, or restoration, of a stable condition during and immediately following an opera…
    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…
    261QP2400XPrison Health Clinic/CenterAmbulatory Health Care Facilities · Clinic/Center
    364SC2300XChronic Care Clinical Nurse SpecialistPhysician Assistants & Advanced Practice Nursing Providers · Clinical Nurse Specialist
    2084A0401XAddiction Medicine (Psychiatry & Neurology) PhysicianA doctor of osteopathy board eligible/certified in the field of Psychiatry by the American Osteopathic Board of Neurology and Psychiatry is able to ob…

    Related ICD-10-CM Codes

    27 rows

    ICD-10-CM CodeDescription
    B34.9Viral infection, unspecified
    E11.9Type 2 diabetes mellitus without complications
    E78.5Hyperlipidemia, unspecified
    F32.9Major depressive disorder, single episode, unspecified
    F41.9Anxiety disorder, unspecified
    F90.0Attention-deficit hyperactivity disorder, predominantly inattentive type
    G43.909Migraine, unspecified, not intractable, without status migrainosus
    H10.9Unspecified conjunctivitis
    H52.4Presbyopia
    I10Essential (primary) hypertension

    Showing 1–10 of 27

    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-98966-TELEPHONE-NONPHYSICIAN-ESTABLISHED-PATIENT-5-10-MINUTES

    CPT 98966: Nonphysician Telephone Evaluation, 5-10 Minutes

    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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