CPT 98972: Nonphysician Online Digital Evaluation (21+ minutes)
Medicare pays $35 and commercial payers pay $42 on average nationally for this procedure.
CPT code 98972 describes an online digital evaluation and management service provided by a qualified nonphysician healthcare professional for an established patient, covering 21 or more minutes of cumulative interactive time over a up to seven‑day period; the service type is nonphysician online/telehealth E/M counseling or management, typically delivered in an ambulatory or remote/telehealth setting using secure online communication technologies for discussion of a health issue and potential treatment or management.
For related coverage guidance, see recent payer policy updates: Lumbar Microdiscectomy, Artificial Cervical Intervertebral Disc, Lumbar Decompression.
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National Reimbursement Benchmarks
Across national payers, Medicare's mean rate of $35.4 sits slightly below BUCA's average commercial mean of $42.3, indicating that commercial arrangements with BUCA tend to pay more than Medicare on average for CPT 98972. Median comparisons are available for several commercial payers and show higher central tendencies at Cigna, UnitedHealth Group, and Blue Cross Blue Shield relative to Medicare's median locality value of $35.
Dispersion measured by the interquartile range (P75–P25) is tightest for Aetna at $4.0 and for Medicare at $2.0, reflecting more consistent reimbursements within those payers/localities. The widest dispersion appears with Cigna at $28.8 and UnitedHealth Group at $27.8, with Blue Cross Blue Shield also showing substantial spread of $15.1, signaling greater variability in commercial contracting outcomes across those networks.