CPT 98970: Online Digital Assessment by Nonphysician (5–10 min)
Medicare pays $13 and commercial payers pay $16 on average nationally for this procedure.
CPT code 98970 describes an online digital communication service where a nonphysician qualified health care professional provides assessment and management of an established patient’s health issue via online technologies, covering 5–10 minutes of cumulative time over a 7-day period; this service is typically a virtual/telehealth outpatient encounter provided from an ambulatory or clinic setting to an established patient using secure messaging or video platforms.
For related coverage guidance, see recent payer policy updates: Lumbar Microdiscectomy, Artificial Cervical Intervertebral Disc, Lumbar Decompression.
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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.