Summary
CPT code 98968 applies to advanced telephone assessments lasting 21–30 minutes, provided by non-physician healthcare professionals. With reimbursement rates between $41 and $73, this code offers a significant opportunity for practices to boost revenue while providing high-value telehealth services.
1. Breaking Down CPT Code 98968
CPT 98968 is designed for extended telephone consultations that require detailed clinical discussions.
Understanding the specific requirements, such as time tracking, patient eligibility, and documentation standards, is essential for billing professionals and administrators to ensure claims are approved and revenue potential is maximized.
For example, a dietitian providing a detailed nutritional plan during a telehealth call can utilize this code effectively if all requirements are met.
Key Requirements for CPT 98968
| Requirement | Details | Notes |
| Time Range | 21–30 minutes | Must be continuous and recorded. |
| Provider Type | Non-physician healthcare professionals | Verify credentials before billing. |
| Patient Type | Established patients only | Ensure patient status before billing. |
| Initiation | Patient-initiated | Must document who initiated the contact. |
| Documentation | Full clinical assessment | Use structured templates to ensure accuracy. |
2. CPT 98968 vs. Related Telehealth Codes
Choosing the correct telehealth code, like 98968, can significantly impact reimbursement rates and compliance.
For instance, while CPT Code 9896 might apply to shorter calls, using 98968 for more in-depth conversations ensures the provider is compensated appropriately.
Medical administrators must train staff to differentiate between codes like 98966–98968 to avoid underbilling or claim denials, especially in practices offering tiered telehealth services.
Understanding where CPT 98968 fits within the telehealth billing framework is crucial for selecting the correct code:
| Code | Duration | Provider Type | 2025 Rates | Best Use Case |
| 98966 | 5–10 minutes | Non-physician | $14–$25 | Brief patient check-ins. |
| 98967 | 11–20 minutes | Non-physician | $27–$49 | Standard phone assessments. |
| 98968 | 21–30 minutes | Non-physician | $41–$73 | Complex cases and follow-ups. |
| 99442 | 21–30 minutes | Physician | $110–$150 | Advanced MD/DO consultations. |
3. Documentation Requirements
Documentation is the backbone of successful billing for CPT 98968. Healthcare administrators and billing specialists must ensure thorough notes, timestamps, and a clear care plan support every telephone interaction.
For example: a speech therapist discussing progress and new exercises with a patient’s caregiver should document the start and end times of the call, findings, and follow-up instructions to validate the service provided.
| Required Element | Details | Verification Method |
| Time Documentation | Start/end times, total call duration | Use EHR auto-timestamps. |
| Clinical Notes | Full assessment, findings, and plan | Progress notes in the patient record. |
| Patient Consent | Agreement for telehealth services | Document verbal consent in records. |
| Care Plan | Recommendations and follow-up actions | Include in care plan or discharge notes. |
4. Regional Reimbursement Insights for 2025
Reimbursement rates for CPT 98968 vary widely based on geographic location, reflecting local market conditions and payer policies.
A practice in the Northeast may earn up to $73 for a claim, while one in the Midwest might receive $62 for the same service.
For medical administrators, understanding these regional trends helps in setting realistic revenue goals and comparing performance across locations.
| Region | Rate Range | Key Factors |
| Northeast | $50–$73 | Higher operating costs. |
| Midwest | $41–$62 | Standard market rates. |
| South | $45–$67 | Competitive telehealth landscape. |
| West | $48–$70 | Variable state regulations. |
5. Implementation Strategy for CPT 98968
A well-structured implementation plan is critical for successfully integrating CPT 98968 into a practice’s billing workflow.
Administrators should focus on training staff, testing processes, and monitoring initial results. For instance, running a one-week trial period with updated EHR templates and time-tracking tools can identify potential bottlenecks and ensure a smoother full rollout.
| Phase | Action Steps | Timeline |
| Planning | Staff training, EHR setup, create templates | Weeks 1–2 |
| Testing | Trial period, gather staff feedback | Weeks 3–4 |
| Full Launch | Go live, monitor performance, make adjustments | Week 5+ |
6. Common Challenges and Solutions
Even experienced medical practices encounter hurdles when billing for CPT 98968, such as missing consent or incorrect code selection.
Addressing these challenges early is crucial. For example, implementing a pre-call checklist can help billing professionals ensure that patient consent is documented and the correct code is selected, reducing claim denials and compliance risks.
| Challenge | Impact | Solution |
| Incomplete Documentation | Denied claims | Use structured templates. |
| Time Tracking Errors | Underpayment | Implement automated systems. |
| Code Selection Errors | Revenue loss | Train staff on code differentiation. |
| Patient Consent Missing | Compliance risk | Use pre-call checklists. |
7. Financial Metrics for Success
Tracking financial performance metrics like clean claim rates and average reimbursement is key to evaluating the success of CPT 98968 implementation.
For instance, practices submitting 120 claims per month with a 93% clean claim rate can expect predictable revenue growth. Administrators can use these metrics to identify areas for improvement and optimize billing processes further.
| Metric | Target | Notes |
| Monthly Claims | 100–150 | Typical volume for active practices. |
| Clean Claim Rate | >93% | Industry benchmark for efficiency. |
| Revenue Per Claim | $57 | Average reimbursement. |
| Monthly Revenue | $5,700–$8,550 | Revenue potential. |
8. Action Steps: Optimizing CPT 98968 Billing
To fully leverage the potential of CPT 98968, practices need a clear roadmap for optimization. From auditing current processes to training staff and monitoring performance, each step contributes to smoother operations and higher revenue.
For example, implementing automated time-tracking tools can significantly reduce errors, allowing billing teams to focus on more complex tasks.
| Step | Action |
| Audit Processes | Review documentation and claim history. |
| Update Systems | Adjust EHR templates and set up alerts. |
| Train Staff | Teach code-specific requirements. |
| Monitor Performance | Track metrics like clean claim rates. |
Conclusion
CPT code 98968 offers substantial revenue potential for practices delivering detailed telephone consultations.
Focus on compliance, proper documentation, and regular monitoring to maximize reimbursement rates. With a clear strategy, your practice can fully leverage the opportunities this code provides in 2025 and beyond.
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