CPT® Code 98967 is used to report a nonphysician healthcare professional’s telephone assessment and management service lasting 11 to 20 minutes. These services are typically provided by qualified providers such as nurses, physician assistants, or other nonphysician clinicians. Telephone assessments may involve evaluation of symptoms, patient education, follow-up care, medication management, and coordination of services without an in-person visit.
Key Facts About CPT® 98967
Service type: Nonphysician telephonic assessment
Provider type: Nurses, physician assistants, or other qualified nonphysician healthcare professionals
Patient type: Established patient
Time range: 11–20 minutes
Medical services included: Yes, evaluation, education, and care coordination via phone
Common clinical indications:
- Follow-up for chronic conditions
- Symptom assessment and triage
- Medication or treatment plan clarification
- Patient education and counseling
- Coordination of referrals or home care services
When to Use CPT® 98967
CPT 98967 is appropriate when:
- A nonphysician provider conducts a telephonic assessment lasting 11–20 minutes
- The service addresses an established patient’s medical concerns
- The assessment involves medically necessary evaluation, education, or care coordination
- Documentation includes time spent and content of the encounter
Examples:
- A nurse calls to assess a patient’s blood pressure readings and adjust care instructions
- Telephone follow-up for a patient recovering from a recent procedure
- Medication counseling for an established patient managing a chronic condition
- Triage and guidance for mild symptom changes in a chronic illness
Documentation Requirements
To support CPT 98967 billing, documentation should include:
- Patient identifiers and date of service
- Duration of the telephone assessment (11–20 minutes)
- Clinical reason for the call
- Summary of evaluation, education, or care coordination provided
- Any recommendations, follow-up instructions, or referrals
- Provider credentials and signature
Complete documentation ensures compliance, supports reimbursement, and facilitates continuity of care.
Reimbursement and Coding Considerations
- CPT 98967 is billed per telephone encounter lasting 11–20 minutes
- Services must be medically necessary and documented with duration and content
- Multiple calls on the same day may require modifier use depending on payer policy
- Coverage may vary based on payer and patient status (established patient)
- Verify payer-specific guidelines for telephonic nonphysician services
Accurate coding and documentation help ensure proper reimbursement and reduce claim denials.
How OptiMantra Supports Nonphysician Telephone Assessments
OptiMantra’s integrated EMR and practice management system streamlines documentation and billing for CPT 98967:
With OptiMantra, providers can:
- Record telephonic encounter details, including duration and clinical content
- Document patient education, symptom assessment, and care coordination
- Track follow-up instructions and patient communications within the patient record
- Link telephone encounters to diagnoses and ongoing care plans
- Support compliant, audit-ready billing codes for nonphysician services
By centralizing telephone assessment documentation and billing, OptiMantra helps practices improve efficiency, maintain compliance, and optimize reimbursement.
Try OptiMantra for free here!
Disclaimer: CPT® codes are maintained by the American Medical Association. This guide is for informational purposes only and does not replace official coding guidelines or payer policies.
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