Summary & Overview
CPT 98968: Nonphysician Telephone Evaluation and Management, 21–30 Minutes
Headline: CPT code 98968: Nonphysician Telephone Evaluation, 21–30 Minutes
Lead: CPT code 98968 represents a telephonic evaluation and management service delivered by a nonphysician qualified healthcare professional to an established patient, parent, or guardian, covering 21 to 30 minutes of medical discussion. The code captures a common remote-care modality that supports access and continuity of care outside traditional visit settings.
Why it matters: As telehealth and remote patient engagement continue to expand, CPT code 98968 serves as a standardized descriptor for time-based telephone management by nonphysician clinicians. Nationally, this code affects documentation, billing consistency, and payer coverage decisions for telephonic patient contacts that do not involve a physician.
Payers covered: This analysis addresses common national payers including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
What readers will learn: The publication provides concise benchmarks for use of CPT code 98968, summarizes payer coverage patterns, outlines clinical contexts where the code is used, and highlights recent policy updates relevant to telephone-based nonphysician services. It also explains documentation and coding elements that typically accompany time-based telephonic encounters. Data not available in the input will be noted as such.
Billing Code Overview
CPT code 98968 describes a telephonic medical discussion provided by a nonphysician qualified healthcare professional with an established patient, parent, or guardian. The service encompasses 21 to 30 minutes of medical discussion about a health issue and potential treatment or management options.
Service Type: Telephone evaluation and management by a nonphysician provider
Typical Site of Service: Remote/telehealth — telephone-based care delivered outside of a clinic or office setting
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical scenario involves an established patient who received outpatient care from a nonphysician qualified healthcare professional (for example, a licensed clinical social worker, physician assistant, or nurse practitioner acting within their scope) and needs follow-up management by telephone. Example: a 42-year-old patient with generalized anxiety disorder who had an in-person visit last week now calls with worsening symptoms and medication questions. The nonphysician clinician spends 22 minutes on the phone reviewing symptom progression, assessing medication adherence and side effects, providing brief supportive counseling, and coordinating a medication adjustment with the supervising physician as needed. The workflow: the patient calls or is scheduled for a telephone follow-up; the nonphysician clinician documents start and stop times totaling 21–30 minutes of medical discussion, documents clinical findings and plan in the medical record, confirms the patient is established, and bills 98968 to the payer with any applicable modifier(s).
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable evaluation and management (E/M) service by the same provider on the same day | When a separate in-person E/M is performed the same day as the telephone service and meets documentation for a distinct E/M |