CPT 98972: Nonphysician Online Evaluation and Management, 21+ Minutes
Headline: CPT code 98972: Nonphysician Online Evaluation and Management for Established Patients
CPT code 98972 represents an online digital evaluation and management service delivered by a nonphysician qualified health care professional to an established patient. The code applies to cumulative online communication time of 21 or more minutes over a seven-day period and serves as a standardized way to report asynchronous or synchronous virtual management by clinicians other than physicians. Nationally, the code matters as telehealth and remote patient management continue to expand across behavioral health, physical therapy, and chronic condition follow-up, offering a billable pathway for nonphysician providers to document sustained digital engagement.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of service definitions and clinical contexts where the code is applied, comparisons to closely related nonphysician digital E/M codes, and practical billing considerations such as time thresholds and expected use cases. The publication highlights common clinical scenarios—behavioral health follow-up, musculoskeletal symptom management, and chronic care check-ins—where cumulative online contact meets the 21-minute threshold. It also outlines what clinicians and billing teams should confirm when coding for virtual nonphysician services and directs readers to related codes for shorter cumulative time intervals. This summary is written for a national audience and focuses on code purpose, scope, and operational context.
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Billing Code Overview
CPT code 98972 describes an online digital evaluation and management service provided by a nonphysician qualified health care professional to an established patient. The service covers 21 or more minutes of cumulative time spent using online communication technologies over a period of up to seven days.
Service type: Nonphysician online digital evaluation and management (telehealth/virtual care)
Typical site of service: Virtual/remote (patient and clinician not co-located); provided via online communication technologies
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.