CPT 98970: Online Nonphysician Assessment, 5–10 Minute Established Patient
CPT code 98970 identifies a brief online communication service in which a nonphysician qualified health care professional discusses a health issue and potential treatment or management with an established patient. The code captures five to ten minutes of cumulative time delivered via online communication technologies during a seven-day period. This service represents an increasingly important channel for remote patient management, mental health follow-up, and allied health triage.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical uses for the code, common settings where it applies, and how it relates to adjacent nonphysician telehealth and telephone assessment codes. The publication summarizes payer coverage patterns, typical documentation and time requirements inherent to the code definition, and operational considerations for coding and billing workflows.
The report provides national-level context on where 98970 fits within digital assessment and management services for nonphysician clinicians, highlights related service lines, and explains common clinical scenarios for use such as brief behavioral health check-ins, allied health remote follow-up, and uncomplicated symptom management. Data not available in the input for certain payer-specific reimbursement rates or utilization benchmarks.
Customize your policy alerts
Sign up for cpt 98970 policy alerts
Get alerted when payer policies referencing 98970 are released or updated.
Monitor payer policy activity
Billing Code Overview
CPT code 98970 describes an online communication encounter in which a nonphysician qualified health care professional discusses a health issue and possible treatment or management with an established patient. The service covers five to ten minutes of cumulative time spent on online communication technologies provided during a period of up to seven days.
Service type: Online digital assessment and management service (synchronous or asynchronous communication) provided by a nonphysician qualified health care professional.
Typical site of service: Remote/virtual care (patient and clinician communicating via online communication technologies); service is delivered outside of a traditional in-person clinic setting.
National Reimbursement Benchmarks
Commercial averages are above Medicare for CPT 98970: Blue Cross Blue Shield and BUCA mean near $15.0 and $15.7 respectively versus Medicare mean $12.7, while UnitedHealth Group and Cigna have higher means near $18.6 and $18.3. This positions Medicare below the primary commercial cluster, with BUCA sitting between Blue Cross Blue Shield and the higher-paying national commercial carriers.
Dispersion measured as P75 minus P25 is tightest for Aetna at $1.9 (P75 $12.9 minus P25 $11.0) and narrow for Medicare at $1.0 (P75 $13 minus P25 $12). The widest spreads appear for Cigna at $10.4 (P75 $22.4 minus P25 $12.0) and UnitedHealth Group at $7.5 (P75 $23.0 minus P25 $12.5), indicating more variability in negotiated commercial rates across those payers.