CPT 98011 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 | Medicine Services and Procedures Acupuncture Procedures |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 98011 |
| Medicaid Fee Schedule | View Medicaid rates for 98011 |
National average reimbursement for CPT 98011 by major payers:
$216.71
$215.42
$144.59
$455.26
CPT 98011 vs. Other Acupuncture Procedures Codes
The CPT 98011 code is part of the Medicine Services and Procedures services used for Acupuncture 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 98011 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 |
|---|---|---|
| 98011-CPT | Moderate | Synch Audio Only New High 60, Synchronous Audio Only Visit For The Evaluation And Management Of A New Patient Which Requires A Medically Appropriate History And/Or Examination High Medical Decision Making And More Than 10 Minutes Of Medical Discussion. When Using Total Time On The Date Of The Encounter For Code Selection 60 Minutes Must Be Met Or Exceeded. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 98011. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 98011 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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