In today’s healthcare environment, practices can’t afford to overlook billable services, especially those that recognize the everyday work your non-physician providers are already doing. One such opportunity is CPT 98966, a simple code for short telephone assessment and management services. While it reimburses less than a traditional E/M visit, when billed consistently and correctly it can add thousands of dollars to your practice each year.

What Is CPT 98966?

CPT 98966 describes a telephone assessment and management service provided by a qualified non-physician healthcare professional (such as a nurse, therapist, or social worker) to an established patient, parent, or guardian.

It applies when:

• The call lasts 5–10 minutes of medical discussion.
• The service is not related to an assessment/E/M visit within the past 7 days.
• The call does not lead to an assessment/E/M service or procedure within the next 24 hours (or soonest appointment).

In short: it captures short, patient-initiated calls that require clinical decision-making but don’t result in a visit.

Billing Rules & Documentation

To bill CPT 98966 appropriately, ensure:

• Patient is established. New patients do not qualify.
• The service is patient-initiated (or initiated by a parent/guardian).
• Documentation includes:

• Duration of the call (5–10 minutes).
• Clinical discussion (symptoms, concerns, guidance provided).
• Diagnoses addressed and any recommended treatment/follow-up.

• Confirm payer coverage as not all commercial plans or Medicaid programs reimburse consistently.
• Calls tied to recent or upcoming visits do not qualify.

How Much Does CPT 98966 Pay?

Payment varies by payer and region:

• Medicare national average: around $12–$15 per call.
• Commercial payers: often higher, averaging $14–$25, and in some cases up to $30+ per call.

(Source: CMS Telehealth List, PayerPrice CPT 98966, AAPC CPT Code 98966)

Revenue Potential for Practices

Individually, $12–$15 may not sound like much. But multiplied across your patient base, CPT 98966 adds up quickly:

Example Scenario:

• 1,000 established patients
• 30% need a qualifying 5–10 minute follow-up call in a year
• Average reimbursement: $15 per call

= 300 billable calls × $15 = $4,500/year in new revenue.

For larger practices with multiple clinicians, the opportunity can easily double or triple. It’s money many practices are currently leaving on the table.

Challenges & Considerations

• Coverage varies: Some payers may deny these services or bundle them into global fees.
• Documentation is critical: Missing the “duration” or evidence that the call was patient-initiated often leads to denials.
• Workflow alignment: Staff must know when a call is billable versus when it should be folded into an upcoming visit.

Action Steps for Practices

1. Audit your calls: Identify how many patient-initiated follow-ups your non-physician staff already handle.
2. Train your team: Make sure they understand the criteria and document duration/content clearly.
3. Update EHR templates: Add a note field for “Patient-initiated call, 5–10 minutes, CPT 98966.”
4. Verify payer policies: Ensure Medicare and commercial contracts allow reimbursement.
5. Track performance: Monitor denial rates and appeal when documentation supports billing.

Bottom Line

CPT 98966 won’t add six figures to your bottom line but it does recognize and reimburse short, clinically meaningful calls your team is already handling. For practices focused on efficiency, compliance, and incremental revenue capture, it’s a code worth billing consistently.

Next Step: Peregrine Healthcare can help your practice identify overlooked billing opportunities like 98966, train staff on documentation, and build workflows that capture every earned dollar.

Contact us today  to schedule a free revenue cycle audit and uncover the hidden value in your patient calls.