Telephone Services: CPT Codes 98966 – 98968
On March 30, 2020, the Centers for Medicare and Medicaid Services (CMS) issued an interim final rule with comment period discussing CPT codes 98966, 98967 and 98968. The description of each of these CPT codes per the American Medical Association CPT 2020 Professional Edition, page 747 are as follows:
98966: Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion
98967: Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion
98968: Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 21-30 minutes of medical discussion
Now that we have the description for each CPT code, lets answer some questions and give an example for each discipline how a physical therapist, occupational therapist and/or speech-language pathologist might utilize these codes.
Question
Are the telephone services CPT codes (98966 – 98968) reimbursed by the Medicare program?
Answer
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Question
Will CMS pay for these telephone services CPT codes if provided by physical therapists, occupational therapists and speech-language pathologists?
Answer
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Question
Will physical therapists, occupational therapists and speech-language pathologists in private practice setting (submit claims on a 1500-claim form) be able to bill these telephone services CPT codes and be paid by the Medicare program?
Answer
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Question – Added April 9, 2020
What are the payment amounts for the telephone services CPT codes?
Answer
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Question
Will the telephone services CPT codes require any modifier(s) to be appended to them on the claim form?
Answer: Updated Answer April 7, 2020
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Question
Will physical therapists, occupational therapists and speech-language pathologists in a non-private practice setting (submit claims on a UB-04 claim form) be able to bill these telephone services CPT codes and be paid by the Medicare program?
Answer
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Question
Must the patient be an established patient under a therapy plan of care?
Answer
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Question
What will the payment amount be for each of the telephone services CPT codes?
Answer
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Question
Can you give an example of when a physical therapist might use one of the telephone services CPT codes?
Answer
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Question
Can you give an example of when an occupational therapist might use one of the telephone services CPT codes?
Answer
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Question
Can you give an example of when a speech-language pathologist (SLP) might use one of the telephone services CPT codes?
Answer
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Do these services need to be patient initiated?
I read that according to the CPT manual you can bill 98967 and 98968 if the call were to take 45 minutes. Is that correct?
The telephone services do not require that the patient initiate the need for the phone call.
Hi Rick,
For these sometime therapy codes would we need to also use the CR modifier?
Thanks for the help!
Karla
In this article, please read the answer to this question:
Question
Will the telephone services CPT codes require any modifier(s) to be appended to them on the claim form?
The President in his proclamation on declaring a national emergency declared the emergency effective March 1, 2020. Will the telephone services CPT codes (98966 – 98968) be covered by the Medicare program beginning March 1?
Per the interim final rule: Effective date: These regulations are effective on March 31, 2020.
Applicability date: These regulations are applicable beginning on March 1, 2020
Are hospital based OP clinics excluded for billing e-visits-telephone visits?
Please read the article and search for the question and answer to your question.
How are these CPT codes different from EVisits? (G2061, 2062 and 2063)
Thanks
G2061-G2063 are not provided via a phone. They are provided via a secure online patient portal.
Is there language that explains or differentiates between E-visits G-codes and Telephone Services CPT codes?
Read my latest article at https://gawendaseminars.com/difference-between-e-visits-and-telephone-services/
Do e-visits still require the CR modifier and the GO, GP, or GN therapy modifier?
Read the most current Q&A’s at https://gawendaseminars.com/e-visits-for-therapy-services/
Hi Rick, Has there been clarification if we are able to bill the telephone codes again for the ongoing weeks of Medicare patient management following the first billable period?
No. Telephone services are billed each date of service that they occur.
Hello. Two questions: 1. If a patient is text messaging you about their swollen post op knee and you text them back can you use these codes? Or does it have to be a voice synchronous conversation?
2. If you have a telephone call on Monday with a patient about their swollen knee can you see them face to face on Tuesday and bill for your telephone visit?
Texting does not meet the definition of a telephone service. If you do a telephone services, per the definition of the code, it could not lead to a visit for the same condition within the next 24 hours or soonest available appointment.
Hey Rick. For the code series 98966, should the POS be listed as 11 or 02?
11
Can you bill 98966 within 7 days before an in-person visit, telehealth or evisit? Is it ok to perform more than one telephone encounter in a 7 day period? Do I bill the cumulative time once (similar to how you can with e-visits) or do you bill each session independently? I appreciate your expertise! Thank you!
For the telephone service CPT codes, please look at the description. They are not cumulative time for a 7-day period.