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See a sample rate comparisonCPT 98013 Fee Schedule
Last Verified: October 2026
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.
Synch Audio Only Est Low 20, Synchronous Audio Only Visit For The Evaluation And Management Of An Established Patient Which Requires A Medically Appropriate History And/Or Examination Low Medical Decision Making And More Than 10 Minutes Of Medical Discussion. When Using Total Time On The Date Of The Encounter For Code Selection 20 Minutes Must Be Met Or Exceeded.
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Acupuncture Procedures |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 98013 |
| Medicaid Fee Schedule | $57.505 median of the 8 states in the free preview · View Medicaid rates for 98013 |
National average reimbursement for CPT 98013 by major payers:
$80.30
$83.51
$65.81
$245.25
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CPT 98013
5 of 25 sample ratesHigher to lower in this preview
Brian Shepherd
Anesthesiology Consultants Exchange, P.C.
$153.63Published rateStephanie Noack
Murfreesboro Medical Clinic, PA
$109.16Published rateJerry Smith
$82.41Published rateNazek Shabayek
Anesthesia Medical Group PC
$76.40Published rateLinda Passini
$60.82Published rate
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See a sample payer proposalCPT 98013 vs. Other Acupuncture Procedures Codes
The CPT 98013 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 98013 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 |
|---|---|---|
| 98013-CPT | Low | Synch Audio Only Est Low 20, Synchronous Audio Only Visit For The Evaluation And Management Of An Established Patient Which Requires A Medically Appropriate History And/Or Examination Low Medical Decision Making And More Than 10 Minutes Of Medical Discussion. When Using Total Time On The Date Of The Encounter For Code Selection 20 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 98013. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 98013 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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Frequently Asked Questions
CPT stands for Current Procedural Terminology. CPT codes are a standardized set of five-digit codes used by medical professionals and payers to describe medical, surgical, and diagnostic services. They are essential for billing and processing claims, ensuring consistency in medical documentation and communication across the healthcare industry.
Finding the exact cost of a medical procedure can be complex due to varying prices based on location, provider, and your insurance plan. To get an estimate, you can contact your healthcare provider's billing department directly. For a more direct way to look up specific prices based on CPT codes and your location, you can use a specialized price transparency tool like Payerprice.
Comparing prices for medical services is crucial for making informed healthcare decisions. Several factors influence pricing, including the healthcare provider, your geographic location, and your specific insurance plan. For a comprehensive way to search for prices, including facility and professional fees, based on CPT codes and your specific location, you should use a dedicated price transparency tool such as Payerprice.
Yes, for specific pricing information tailored to your CPT code and location, you can use a price transparency tool like Payerprice. Payerprice offers a fee schedule lookup tool that allows users to search with a CPT code and specific location to find relevant cost data. This can help you understand potential costs for medical services before receiving them, aiding in financial planning for your healthcare.
Medical costs vary significantly due to a multitude of factors. These include differences in negotiated rates between providers and insurance companies, geographic location (cost of living, competition), facility type (e.g., hospital vs. outpatient clinic), technology and equipment used, provider reputation, and whether the service is in-network or out-of-network. For understanding these variations in specific terms, using a tool like Payerprice can provide insights into actual fee schedules and help clarify cost differences.