CPT 98971: Nonphysician Digital Assessment and Management, 11–20 Minutes
CPT code 98971 designates an online digital assessment and management encounter by a nonphysician qualified healthcare professional for an established patient, covering 11–20 minutes of cumulative time over a seven-day period. This code standardizes reimbursement for remote, asynchronous or synchronous patient communication managed by clinicians such as physical therapists, occupational therapists, or registered nurses, and supports broader telehealth and virtual care workflows nationwide. Its presence reflects the growing role of nonphysician clinicians in virtual chronic care management and patient follow-up.
Key payers evaluated include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code’s clinical and billing intent, the typical service setting, and how it relates to adjacent codes that capture shorter or longer cumulative time blocks. The publication summarizes fee-schedule considerations and common billing practices tied to this code, highlights operational implications for virtual care teams, and outlines potential coding interactions clinicians should monitor when delivering remote, time-based nonphysician services.
This analysis is written for a national audience and focuses on practical clarity around code definition, payer coverage presence, and clinical context for teams integrating remote nonphysician digital assessment into patient care.
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Billing Code Overview
CPT code 98971 describes online digital assessment and management services provided by a nonphysician qualified healthcare professional to an established patient. The service covers 11 to 20 minutes of cumulative time spent during a seven-day period using online communication technologies to discuss a health issue and possible treatment or management.
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Service type: Remote digital assessment and management by a nonphysician qualified healthcare professional
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Typical site of service: Virtual/remote (online communication technologies) for established patients
National Reimbursement Benchmarks
Commercial averages sit noticeably above Medicare for CPT 98971: Blue Cross Blue Shield, Cigna, UnitedHealth Group and BUCA all show mean rates higher than Medicare’s mean of $23.7, with BUCA’s mean at $27.5 highlighting a modest commercial premium relative to Medicare. Cigna and UnitedHealth Group have the highest commercial means at $32.5 and $33.6 respectively, indicating that commercial payers are paying materially more than the Medicare average for this code. Rate dispersion (P75 minus P25) varies across payers, reflecting different consistency in contracted rates. Blue Cross Blue Shield’s interquartile spread is $9.50 (P75 $29.20 minus P25 $19.70) and Cigna’s spread is $17.00 (P75 $39.90 minus P25 $20.90), making Cigna one of the widest. UnitedHealth Group’s spread is $19.00 (P75 $41.60 minus P25 $22.60), the widest among payers with full quartiles; Aetna is tighter at $3.30 (P75 $22.30 minus P25 $19.00), and BUCA’s spread is $11.60 (P75 $31.90 minus P25 $20.30). Medicare’s interquartile spread is narrow at $1.00 (P75 $24 minus P25 $23), indicating the most consistent national locality-based rates.