CPT Code 98966: Telephone Assessment and Management Service, 5–10 Minutes

What is CPT code 98966?

The Current Procedural Terminology (CPT) code 98966 is used for telephone assessment and management services provided by qualified nonphysician health care professionals for established patients. This CPT code covers audio-only telephone services lasting 5-10 minutes of medical discussion that do not originate from a related assessment and management service provided within the previous 7 days and do not lead to an assessment and management service or procedure within the next 24 hours or the soonest available appointment.

Telephone assessment is included under telehealth services, as well as evaluation and management services for patient concerns, conducted through structured phone conversations between healthcare professionals and patients.

The CPT code 98966 specifically applies when a qualified health care professional who is a non-physician, such as a nurse practitioner, physician assistant, clinical nurse specialist, physical and occupational therapist, and registered dietitian, provides telephone consultations for established patients requiring clinical guidance.

The 98966 CPT code covers cumulative time spent in direct patient communication lasting between 5-10 minutes of medical discussion. This timeframe includes the actual clinical conversation between the qualified health care professional and the patient, parent, or guardian, focusing on assessment of symptoms, clinical concerns, or management of ongoing conditions.

Documentation requirements

Proper documentation for CPT code 98966 requires a comprehensive recording of the telephone assessment and management service provided to the established patient. The clinical record must clearly identify the qualified nonphysician health care professional providing the service, document patient consent for the telephone consultation, and record the specific clinical concerns addressed during the call.

Documentation should include the following:

• Date and duration of the phone call
• Clinical issues discussed
• Recommendations provided
• The professional's clinical assessment of the patient's condition

The record must demonstrate that the service involved substantive medical discussion requiring clinical judgment rather than routine administrative communication.

Billing guidelines

Billing for CPT code 98966 varies significantly among different payers, with many private insurance policies and Medicaid services having specific coverage limitations for telephone assessment services. Healthcare professionals should verify coverage policies with individual payers before providing telephone consultations, as reimbursement rates and coverage criteria differ substantially across insurance plans.

Private payers may have varying requirements for patient consent documentation, service frequency limitations, or specific clinical criteria that must be met for reimbursement. Some private insurance policies may not cover telephone assessment and management services, while others may require prior authorization or have specific billing requirements that differ from standard evaluation and management services.

Other relevant codes

The following CPT codes commonly relate to telephone assessment and management services and may be used as alternatives or in conjunction with CPT 98966:

• 98967 - Telephone assessment and management service by qualified nonphysician healthcare professional, 11-20 minutes
• 98968 - Telephone assessment and management service by qualified nonphysician healthcare professional, 21-30 minutes
• 99441 - Telephone evaluation and management service by physician, 5-10 minutes
• 99442 - Telephone evaluation and management service by physician, 11-20 minutes
• 99443 - Telephone evaluation and management service by physician, 21-30 minutes