CPT 98968, in plain terms, covers Telephone assessment and management by a qualified nonphysician health professional for an established patient, 21 to 30 minutes of medical discussion. CPT 98968 is referenced in 12 tracked payer policy changes from Sentara Health Plans, Independence Blue Cross, and 7 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 98968 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Official descriptor: CPT 98968 on AAPC
Starting January 1, 2027, Sentara Health Plans will require prior authorization for a long list of codes on Virginia commercial plans, including self-funded (ASO) plans, and for code 88380 on commercial, Medicaid and Medicare products, plus code 22860 on Medicare products. Sentara will also stop covering a separate list of codes on Virginia commercial and self-funded plans.
Independence Blue Cross expanded telemedicine coverage effective 01/01/2026 to include all specialties using synchronous two-way audio, asynchronous store-and-forward, and audio-video methods at the same standard of care as in-person services. Thirteen previously non-covered codes (98966, 98967, 98968, 98970, 98971, 98972, G2061, G2062, G2063, G0071, G2010, G2250, G2251, G2252) are now eligible for reimbursement. The GQ modifier is now an eligible billing modifier for telemedicine services.
Independence Blue Cross expanded telemedicine coverage effective 01/01/2026 to include all specialties with synchronous audio-only and asynchronous communications options. Thirteen previously non-covered CPT/HCPCS codes (98966-98972, G2061-G2063, G0071, G2010, G2250-G2252) are now eligible for reimbursement. The GQ modifier is now an eligible billing modifier for telemedicine claims.
The HCPCS code lists used for skilled nursing facility consolidated billing are updated effective October 1, 2026, with implementation on October 5, 2026. Codes added to the Part A and Part B lists include 1027T, C1609, 1050T, 1051T, 90616, 90639 and 1036T, and certain therapy codes are removed from Part B SNF CB File #1 and remain on File #4. The update also corrects therapy codes that had been included in both Part B SNF CB File #1 and File #4.
CMS's October 2026 quarterly update revises the lists of HCPCS codes subject to skilled nursing facility (SNF) consolidated billing (CB), with an effective date of October 1, 2026 and an implementation date of October 5, 2026. Therapy codes that were inadvertently in both Part B SNF CB File #1 and File #4 are removed from File #1 and remain assigned to File #4. Other codes are added to or terminated from the Part A and Part B SNF CB files, with some of those changes effective on earlier dates.
Oregon Medicaid updated behavioral health fee schedule rates effective January 1, 2026, with most rates increasing by $0.47 to $6.21 per service. The changes align with CMS updates to relative value units and are mandated by federal standards.
Point32Health will now cover early intervention services at ABA centers for Tufts Health Together members when clinically justified, effective Nov 28, 2025. Services must be billed using T1015-TL (per 15 minutes), and telephonic codes 98966, 98967, and 98968 are no longer covered for early intervention.
South Dakota Medicaid is replacing discontinued telephone consultation codes (98966-98968) with new audio-only E/M codes (98012-98015) for established patient visits. The new codes have specific time and medical decision-making requirements with updated reimbursement rates.
Effective May 1, 2017, for claims with dates of service on or after that date, insulin pumps and glucose monitoring systems (Commercial only) and upper gastrointestinal endoscopy no longer require prior authorization through the web-based preauthorization tools, and CPT 69711 no longer requires prior authorization for Commercial products for dates of service on or after June 1, 2017. Effective April 1, 2017, HCPCS code C9484 is not medically necessary, C9487 is subject to medical review, and C9485, C9486 and C9488 are invalid for professional providers. Effective February 1, 2017, proprietary lab analysis codes 0001U and 0002U are invalid and 0003U is not medically necessary for Commercial products.
Already effective September 1, 2017, BCBSRI requires providers to report the name and Type 1 NPI of the ordering provider on the CMS-1500 claim or electronic submission for laboratory, imaging, durable medical equipment and home infusion services, and missing or incomplete information results in the claim being rejected back to the provider. Already effective January 1, 2017, CPT 62320, 62322, 62324 and 62326 changed from not medically necessary to medically necessary with prior authorization, and CPT 83861 is covered and separately reimbursed for commercial and BlueCHiP for Medicare products. Already effective September 1, 2017, CPT 92227 and 92228 are covered for BlueCHiP for Medicare only when filed by an optometrist or ophthalmologist, and CPT 92228 is not medically necessary for commercial products for other indications.
The IHCP answered COVID-19 policy questions from a live webinar held April 15, 2020. These policies are in effect until the end of the national public health emergency. Telemedicine services are billed with place of service and modifier rules set by code, and prior authorizations are not automatically extended.
BCBSAZ covers telehealth only as the member's benefit plan provides. Under the BlueCare Anywhere benefit, telehealth is covered when the Telehealth Services Administrator provides the service and determines the condition is appropriate, for a medical, therapy or psychiatry consultation. Under the in-network telehealth benefit, a service is covered when it would be covered in person and can be provided effectively by telehealth, through audio-visual services or limited audio-only services, and out-of-network non-emergency telehealth is not covered. The most recent review, dated 07/29/26, made no revisions.
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