98966 CPT Code: Know Your Codes

July 5, 2020CPT Codes

98966 CPT Code Description

98966 CPT Code: 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.

As a therapist, you expect to receive phone calls from clients. Many practitioners don’t charge for short calls, especially if they’re for scheduling purposes, but what do you do when a phone call from a client becomes more complex and essentially turns into its own session? You may be able to use CPT codes 98966-98968. These codes differ by telephone discussion times, which are:

• 98966 CPT Code: 5-10 minutes
• 98967 CPT Code: 11-20 minutes
• 98968 CPT Code: 21-30 minutes

If the call lasts longer than 30 minutes, you can use more than one of these codes. For example, a 45-minute call can be billed as both 98968 and 98967.

What is the difference between Telehealth services and telephone calls?

Telehealth services are live Interactive Audio and Visual Transmissions of a physician-patient encounter from one site to another, using telecommunications technologies. Telephone calls are non-face to face medical discussions, between a physician or other healthcare professional and a patient, that do not require direct, in-person contact.

CMS Update for Telephone Calls

Updated May 9, 2020, with information from the 4/30/20 rule

• CMS will pay for phone calls using codes 99441—99443. The 4/30/20 rule adds these to the telehealth list and increased payment for these services
• CMS continues did not add 98966–98968 to the telehealth list
• These codes previously had a non-covered status
• Physicians, nurse practitioners, and physician assistants should use codes 99441—99443
• Other qualified health care professionals who may bill Medicare for their services, such as registered dietitians, social workers, speech language pathologists and physical and occupational therapists should use codes 98966—98968
• New! 99441–99443 have been added to the telehealth list, so use the place of service that would have been furnished. In most cases, this will be place of service office (11) or outpatient department (19, 22). Since they are now telehealth services, add modifier 95

These phone call codes had a status indicator of non-covered, but are now covered services. Per the CPT definition, phone call codes 99441—99443 and 98966—98968 are services initiated by the patient. Physicians, nurse practitioners, clinical nurse specialists, certified nurse-midwives and physician assistants use these codes.

98966 CPT Code Reimbursement 2020

Getting Paid for Telephone Calls

There are high chances that your claim may be denied, as these codes are often not covered. That’s why it’s important to check the contract to see if these codes are covered and have a policy in place to ensure you’re compensated for your time if they’re not. The best place to do this is on the Consent for Services form you have your clients sign. Make part of this form your out-of-session contact policy, stating that clients will be liable for all charges not covered by insurance. Naturally, this will exclude Qualified Medicare Beneficiaries and some Medicaid clients, who can’t be billed for anything, but it will cover your bases with all other clients.

After each phone call that you want to bill, submit the claim to the insurance company for reimbursement. Even if it seems likely to be denied, this will prove to your client that you attempted reimbursement and thus have a valid reason for charging them directly. You could also make the phone call eligible for HSA reimbursement by coding it as a medical procedure.

CPT © Copyright 2021 American Medical Association

For accurate medical billing, knowing your CPT codes is the most important thing. In our blog series of ‘Know Your Codes’ or ‘KYC,’ we have discussed the most common CPT codes in detail and when to use them. E2E Medical Billing Services is known for it’s accurate and affordable medical billing services. To know more about our medical billing services call us at 888-552-1290 or write to us at info@e2eMedicalBilling.com