CPT 76098 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Radiology Procedures • Diagnostic Radiology (Diagnostic Imaging) Procedures |
| Common Place of Service | • 22 - On Campus Outpatient Hospital • 11 - Office |
| Common Modifiers | • None • 26 - Professional component • LT - Left side of body |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 76098 |
National average reimbursement for CPT 76098 by major payers:
$45.63
$36.76
$41.46
$49.68
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 76098 | ||||||
United | 76098 | $1357.06 | 1760513980 - INOVA HEALTH CARE SERVICES, INOVA FAIR OAKS HOSPITAL | 540620889 - INOVA HEALTH CARE SERVICES | VA | General Acute Care Hospital (282N00000X) |
United | 76098 | $8.27 | 1407825342 - ELITE IMAGING OF FAIRVIEW HEIGHTS, LLC | 770620606 - (IL) ELITE IMAGING OF FAIRVIEW HEIGHTS LLC | IL | Radiology Clinic/Center (261QR0200X) |
United | 76098 | $29.95 | 1922857994 - TAYLOR SCHWER | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | FL | Nurse Practitioner (363L00000X) |
United | 76098 | $407.22 | 1972503910 - WACCAMAW COMMUNITY HOSPITAL, TIDELANDS WACCAMAW COMMUNITY HOSPITAL | 43633263 - WACCAMAW COMMUNITY HOSPITAL | SC | General Acute Care Hospital (282N00000X) |
United | 76098 | $4.96 | 1306380951 - VILLAPARK MEDICAL IMAGING INC | 812401668 - (IL) VILLAPARK MEDICAL IMAGING INC | IL | Radiology Clinic/Center (261QR0200X) |
United | 76098 | $706.52 | 1396837951 - CENTRAL IOWA HOSPITAL CORPORATION, IOWA METHODIST MEDICAL CENTER | 420680452 - CENTRAL IOWA HOSPITAL CORPORATION | IA | General Acute Care Hospital (282N00000X) |
United | 76098 | $505.66 | 1568481984 - MERCY HOSPITAL SOUTH | 430980256 - (MO) MERCY HOSPITAL SOUTH | MO | General Acute Care Hospital (282N00000X) |
United | 76098 | $21.98 | 1336501832 - NING DONG | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | FL | Hematology & Oncology Physician (207RH0003X) |
United | 76098 | $482.89 | 1154618742 - VHS HARLINGEN HOSPITAL COMPANY LLC, VALLEY BAPTIST MEDICAL CENTER | 452662980 | TX | General Acute Care Hospital (282N00000X) |
United | 76098 | $963.15 | 1407313760 - HH HEALTH SYSTEM, MARSHALL MEDICAL CENTER | 831651180 | AL | General Acute Care Hospital (282N00000X) |
United | 76098 | $965.78 | 1003925959 - HOSPITAL SERVICE DISTRICT 2 OF THE PARISH OF TANGIPAHOA STATE OF LA., HOOD MEMORIAL HOSPITAL | 720694946 - (LA) HOSPITAL SERVICE DISTRICT 2 OF THE PARISH OF TANGIPAHOA STATE OF LA | LA | Critical Access Hospital (282NC0060X) |
United | 76098 | $418.76 | 1811971302 - MEDICAL UNIVERSITY OF OHIO AT TOLEDO, UNIVERSITY OF TOLEDO MEDICAL CENTER | 340967014 | OH | General Acute Care Hospital (282N00000X) |
United | 76098 | $44.29 | 1003201955 - MERCY HOSPITAL CARTHAGE | 453808607 - MERCY HOSPITAL CARTHAGE | MO | Critical Access Hospital (282NC0060X) |
United | 76098 | $1678.06 | 1851686059 - SWEDISH HEALTH SERVICES, SWEDISH/ISSAQUAH | 910433740 - (WA) SWEDISH HEALTH SERVICES | WA | General Acute Care Hospital (282N00000X) |
United | 76098 | $12.85 | 1053334441 - TEXARKANA PET/CT IMAGING INSTITUTE, L.P. | 721513569 - (TX) TEXARKANA PETCT IMAGING INSTITUTE LP | TX | Radiology Clinic/Center (261QR0200X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 76098 vs. Other Diagnostic Radiology (Diagnostic Imaging) Procedures Codes
The CPT 76098 code is part of the Radiology Procedures services used for Diagnostic Radiology (Diagnostic Imaging) Procedures. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 76098 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 76000-CPT | Low | Fluoroscopy (Separate Procedure) Up To 1 Hour Physician Or Other Qualified Health Care Professional Time (Desc Revised 1/1/2018) |
| 76010-CPT | Low | X-Ray From Nose To Rectum For F.B.,1 Fil |
| 76080-CPT | Low | Rad Exam Fistula Sinus Tract Study Rad S |
| 76098-CPT | Low | X-Ray Breast Surgical Specimen |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 76098. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 76098 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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