Billing for Phone Calls with CPT Codes 98966, 98967, and 98968

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.

Here’s what you need to know.

Defining 98966-98968

According to the CPT manual, the 98966, 98967, and 98968 CPT codes are used for "telephone assessment and management service provided by a qualified non-physician health care professional to an established client, parent or guardian."

The call can’t originate from a related assessment and management service provided within the previous 7 days or lead to an assessment and management service or procedure within the next 24 hours or soonest-available appointment.

These codes differ by telephone discussion times, which are:

• 98966: 5-10 minutes
• 98967: 11-20 minutes
• 98968: 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.

Billing requirements

To fulfill medical necessity, the following criteria must be met when billing 98966-98968:

• The call must be initiated by the established client or their parent/guardian if they’re a minor.
• The length of the phone call must be documented, as well as the nature of the service and other pertinent information.
• The call can’t be related to an E/M service you performed and reported within the last 7 days.

How to get paid for calls

Unfortunately, you can satisfy every billing requirement and still not be reimbursed by the insurance company for client calls, since 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.

We’ll cover more codes in the future, so make sure you subscribe to our blog below to get notified of new posts.

Sources: CPT® (Current Procedural Terminology), American Medical Association; Telephone Services, University of California, Davis; Medicare Claims Processing, Department of Health & Human Services; Telemedicine Policy, United Healthcare® Oxford

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