CPT 98971: Nonphysician Online Assessment and Management (11–20 min)
Medicare pays $24 and commercial payers pay $28 on average nationally for this procedure.
CPT code 98971 describes an online digital evaluation and management service provided by a nonphysician qualified health care professional for an established patient, covering 11 to 20 minutes of cumulative time over a 7-day period; the service type is nonphysician online assessment and management and the typical site of service is remote/telehealth (asynchronous or synchronous digital communication) for established patients.
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 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.