Case Management Service Codes

For Qualified Nonphysician Health Care Professionals

Medical Team Conferences | Telephone Assessments | Online Medical Evaluations

The codes listed on this page are not recognized by Medicare. However, other health plans may elect to cover them. Check with your payers.

Medical Team Conferences

If you participate in medical team conferences for a patient's care, you may use medical team conference CPT codes to report 30 minute or longer meetings that meet certain criteria. These should be of special interest to those involved in cleft palate teams or other medical teams.

99366 Medical team conference with interdisciplinary team of health care professionals, face-to-face with patient and/or family, 30 minutes or more; participation by nonphysician qualified health care professional

99368 Medical team conference with interdisciplinary team of health care professionals, patient and/or family not present, 30 minutes or more; participation by nonphysician qualified health care professional

Criteria

The following criteria must be met to report the team conference codes:

• A minimum of three qualified health care professionals from different specialties or disciplines who provide direct care to the patient must participate in the reported team conference.
• No more than one individual from the same specialty may report 99366-99368 at the same encounter.
• Reporting participants must be present for the entire team conference.
• Reporting participants shall have performed face-to face evaluations or treatments of the patient, independent of any team conference, within the previous 60 days.

Reporting participants should record their role in the conference, contributed information, and subsequent treatment recommendations. The time for the team conference starts at the beginning of the case review and ends at the conclusion of the review. Record keeping or report generation time is not included. However, the time is not limited to the time that the participant is addressing the team or patient/family.

Physicians will be able to report 99367 for a medical team conference with an interdisciplinary team of health care professionals, patient and/or family not present, 30 minutes or more. Physicians are referred to evaluation and management codes for one comparable to 99366.

Telephone Assessments

There are three codes for reporting services provided over the telephone. The telephone assessment codes are for "non-face-to-face assessment and management services provided by a qualified health care professional to a patient using the telephone. These codes are used to report episodes of care by the qualified health care professional initiated by an established patient or guardian of an established patient."

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 seven days nor leading to an assessment and management service or procedure with the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion

98967 11-20 minutes of medical discussion

98968 21-30 minutes of medical discussion

Certain conditions preclude the use of the codes:

• They cannot be used if the patient is seen within 24 hours of the phone call or during the next available urgent visit appointment, or
• if the patient was seen within the previous seven days.

Online Medical Evaluations

98969 Online assessment & management service provided by a qualified nonphysician health care professional to an established patient, guardian, or health care provider not originating from a related assessment & management service provided within the previous 7 days, using the Internet or similar electronic communications network.