CPT 99367 Reimbursement & Policy Benchmarks

Headline: CPT code 99367: Physician Participation in Multidisciplinary Team Meeting for Treatment Planning

Lead: CPT code 99367 documents a physician’s participation in a multidisciplinary team meeting to formulate or modify a treatment plan for a patient who requires input from multiple specialties. The code captures interdisciplinary care coordination activities that support complex cases and care-plan alignment across specialists.

Why it matters: Multidisciplinary team conferences are central to managing complex patients, reducing fragmentation of care, and aligning treatment strategies across specialties. Accurate use of CPT code 99367 ensures clinical activities are captured for administrative records and supports measurement of collaborative care efforts nationally.

Key payers: Analysis covers major national payers including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.

What readers will learn: The publication provides a concise explanation of the service defined by CPT code 99367, the clinical context for use, and how this code fits into interdisciplinary care workflows. Readers will find guidance on typical sites of service and expected service type. Where available, the report outlines benchmark considerations, common billing modifiers (input provided separately), and policy or coverage considerations relevant to national payers. Data not available in the input is identified explicitly in relevant sections.

Billing Code Overview

CPT code 99367 describes a service in which a physician participates as a member of a multidisciplinary team meeting to discuss a patient's treatment plan when the patient requires attention from more than one medical specialty. The service type is interdisciplinary team conference / care coordination consultation. The typical site of service for this activity is an outpatient or inpatient setting where multidisciplinary case conferences are convened, such as hospital conference rooms, outpatient clinic team meetings, or other clinical meeting spaces.

Clinical Context

A 68-year-old male with complex comorbidities (heart failure, chronic kidney disease, and newly diagnosed advanced lung cancer) is admitted to a tertiary care hospital. The primary pulmonologist requests a multi-disciplinary tumor board meeting to establish a coordinated treatment plan involving medical oncology, radiation oncology, thoracic surgery, palliative care, and nephrology. A consulting physician (for example, a cardiologist or thoracic surgeon) joins the scheduled meeting to present specialty-specific assessment and to participate in decision-making about sequencing of systemic therapy, perioperative risk mitigation, and dialysis management during planned procedures. The physician documents participation in the team meeting, the topics discussed, the specialties represented, and the contribution to the treatment plan. Billing is per occurrence for the physician’s professional participation in the interdisciplinary care conference when the patient requires attention from more than one medical specialty and the physician’s presence is medically necessary to formulate or modify the treatment plan.

Coding Specifications

Modifier	Description	When to Use
`11`	Provider default or usual charge	Applied when no other modifier is appropriate and the service is provided as usual.
`22`

Taxonomy Code	Specialty	Notes
`207RC0000X`	Pulmonary Disease (Pulmonology)	Frequently leads or participates in tumor board discussions for thoracic malignancy.
`207L00000X`	Medical Oncology	Central to systemic therapy planning and multi-specialty treatment coordination.
`207XS0112X`	Thoracic Surgery	Provides surgical assessment and perioperative risk input in the meeting.
`2084P0800X`	Radiation Oncology	Contributes radiation planning and sequencing considerations.
`207Q00000X`	Cardiology	Consults for cardiac risk assessment in patients with comorbid cardiac disease involved in multi-disciplinary planning.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C34.90`	Malignant neoplasm of unspecified bronchus or lung, unspecified laterality	Common reason for multidisciplinary tumor board review involving pulmonology, oncology, and thoracic surgery.
`I50.9`	Heart failure, unspecified	Cardiology input may be required during multi-specialty planning for patients with significant cardiac comorbidity.
`N18.9`	Chronic kidney disease, unspecified	Nephrology involvement is often necessary when planning systemic therapy or perioperative care for patients with renal impairment.
`Z51.11`	Encounter for antineoplastic chemotherapy	Treatment planning for chemotherapy sequencing and coordination is a frequent meeting topic.
`Z51.0`	Encounter for radiotherapy	Radiation oncology participation to discuss radiotherapy indications and timing.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99223`	Initial hospital care, typically 70 minutes or more	Preceding inpatient evaluation by the attending physician that may lead to referral to the interdisciplinary team meeting.
`99233`	Subsequent hospital care, typically 35 minutes	Ongoing inpatient management that documents implementation of the plan generated by the team meeting.
`99354`	Prolonged physician service in the outpatient or office setting, requiring direct patient contact beyond the usual service (first hour)	Used when extended interdisciplinary coordination requires additional physician time beyond standard encounters.
`99214`	Office or other outpatient visit for the evaluation and management of an established patient, typically 25 minutes	Ambulatory follow-up visit to discuss outcomes of the team meeting and to refine the treatment plan.
`99499`	Unlisted evaluation and management service	Used for complex care coordination activities not described by standard CPT codes when appropriate by payer policy.

OpenPayer

Summary & Overview

CPT 99367: Physician Participation in Multidisciplinary Team Treatment Planning