How To Use CPT Code 98970

CPT 98970 describes the online digital assessment and management services provided by a qualified, nonphysician healthcare professional to an established patient for up to 7 days. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 98970?

CPT 98970 can be used to describe the online digital assessment and management services provided by a qualified, nonphysician healthcare professional to an established patient. This code covers a cumulative time of 5 to 10 minutes spent with the patient over a period of up to 7 days. The healthcare professional communicates with the patient via online communication technologies to address a health issue, provide treatment recommendations, and offer management strategies.

2. Official Description

The official description of CPT code 98970 is: ‘Qualified nonphysician health care professional online digital assessment and management, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes.’

3. Procedure

1. The nonphysician healthcare professional communicates with the established patient via online communication technologies.
2. During the encounter, the healthcare professional addresses the patient’s health concerns, answers medical questions, and recommends appropriate management strategies.
3. The healthcare professional documents the encounter in the patient’s record and may follow up with the patient via telephone or email.
4. CPT code 98970 covers a cumulative time of 5 to 10 minutes spent in communication with the patient over a period of up to 7 days.

4. Qualifying circumstances

CPT 98970 is applicable to established patients who require online digital assessment and management services. The healthcare professional must be a qualified, nonphysician professional, and the patient must have been seen by the same provider or any provider in a group practice within the past 36 months. The communication must address a health issue, and the services provided should include responding to the patient’s concerns, answering medical questions, and recommending appropriate management strategies.

5. When to use CPT code 98970

CPT code 98970 should be used when a qualified, nonphysician healthcare professional provides online digital assessment and management services to an established patient for a cumulative time of 5 to 10 minutes over a period of up to 7 days. This code is appropriate for addressing health concerns, answering medical questions, and providing treatment recommendations or management strategies via online communication technologies.

6. Documentation requirements

To support a claim for CPT 98970, the healthcare professional must document the following information:

• Established patient status
• Details of the online communication technologies used
• Date and time of each communication session
• Health concerns addressed and medical questions answered
• Treatment recommendations or management strategies provided
• Follow-up actions, if any
• Signature of the qualified, nonphysician healthcare professional providing the service

7. Billing guidelines

When billing for CPT 98970, ensure that the healthcare professional providing the service is a qualified, nonphysician professional. The cumulative time spent in communication with the patient over a period of up to 7 days should be between 5 and 10 minutes. It is important to note that CPT code 98970 should not be reported if CPT codes 98971 or 98972 are already reported for the same patient within the same 7-day period. Additionally, check with individual insurance companies for specific guidelines and reimbursement policies.

8. Historical information

CPT 98970 was added to the Current Procedural Terminology system on January 1, 2020. There have been no updates to the code since its addition.

9. Examples

1. A nurse practitioner providing online digital assessment and management services to an established patient for 7 days, spending a cumulative time of 5 to 10 minutes addressing the patient’s concerns and recommending appropriate treatment strategies.
2. A physical therapist communicating with an established patient via online communication technologies to provide guidance on exercises and pain management strategies, spending a cumulative time of 5 to 10 minutes over a period of 7 days.
3. A physician assistant addressing a patient’s medical questions and providing treatment recommendations via online communication technologies for a cumulative time of 5 to 10 minutes over a period of 7 days.
4. A nurse providing online digital assessment and management services to an established patient, discussing medication adjustments and monitoring strategies, spending a cumulative time of 5 to 10 minutes over a period of 7 days.
5. A social worker communicating with an established patient via online communication technologies to provide counseling and support, spending a cumulative time of 5 to 10 minutes over a period of 7 days.
6. A respiratory therapist addressing an established patient’s respiratory concerns and providing management strategies via online communication technologies, spending a cumulative time of 5 to 10 minutes over a period of 7 days.
7. A nurse practitioner discussing lifestyle modifications and self-care strategies with an established patient via online communication technologies, spending a cumulative time of 5 to 10 minutes over a period of 7 days.