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See a sample rate comparisonCPT 98960 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.
Self Mgmt Educ Train 1 Pt, Education And Training For Patient Self Management By A Qualified Nonphysician Health Care Professional Using A Standardized Curriculum Face To Face With The Patient Could Include Caregiver Family Each 30 Minutes Individual Patient
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Education and Training for Patient Self-Management |
| Common Place of Service | 11 - Office |
| Common Modifiers | GT - Via interactive audio and video telecommunication systems U2 |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 98960 |
| Medicaid Fee Schedule | $27.11 median of the 7 states in the free preview · View Medicaid rates for 98960 |
National average reimbursement for CPT 98960 by major payers:
$34.68
$33.80
$34.25
$54.49
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CPT 98960
5 of 25 sample ratesHigher to lower in this preview
Asim Khokhar
Stony Brook Internists P C
$100.88Published rateDavid Gutman
Archbold Medical Group Inc
$47.86Published rateGeorge Surla
Greater New York Gastroenterology, LLP
$37.22Published rateZachary Devore
Sjr Medical PC
$31.45Published rateJaydeep Kadam
Long Island Medical PC
$22.32Published rate
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See a sample payer proposalCPT 98960 vs. Other Education and Training for Patient Self-Management Codes
The CPT 98960 code is part of the Medicine Services and Procedures services used for Education and Training for Patient Self-Management. 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 98960 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 |
|---|---|---|
| 98960-CPT | Low | Self Mgmt Educ Train 1 Pt, Education And Training For Patient Self Management By A Qualified Nonphysician Health Care Professional Using A Standardized Curriculum Face To Face With The Patient Could Include Caregiver Family Each 30 Minutes Individual Patient |
| 98961-CPT | Low | Self Mgmt Educ Train 2 4 Pt, Education And Training For Patient Self Management By A Qualified Nonphysician Health Care Professional Using A Standardized Curriculum Face To Face With The Patient Could Include Caregiver Family Each 30 Minutes 2 4 Patients |
| 98962-CPT | Low | Self Mgmt Educ Train 5 8 Pt, Education And Training For Patient Self Management By A Qualified Nonphysician Health Care Professional Using A Standardized Curriculum Face To Face With The Patient Could Include Caregiver Family Each 30 Minutes 5 8 Patients |
| 98966-CPT | Low | Hc Pro Phone Call 5 10 Min, Telephone Assessment And Management Service Provided By A Qualified Nonphysician Health Care Professional To An Established Patient Parent Or Guardian Not Originating From A Related Assessment And Management Service Provided Within The Previous 7 Days Nor Leading To An Assessment And Management Service Or Procedure Within The Next 24 Hours Or Soonest Available Appointment 5 10 Minutes Of Medical Discussion |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 98960. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 98960 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 code 98960 is used by healthcare providers for education and training for patient self-management by a qualified nonphysician health care professional, face-to-face with an individual patient, for each 30 minutes, using a standardized curriculum. It addresses moderate-level medical decision-making.
Factors affecting the fee schedule for CPT 98960 include Medicare & Medicaid rates (government-set), Private Insurance rates (negotiated between providers and insurance companies), Geographic Location (costs may be higher in urban areas), and Provider Type (hospital providers may have different rates than private practice).
CPT 98960 is part of the Medicine Services and Procedures for Education and Training for Patient Self-Management. It represents a moderate-complexity encounter involving more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. Other codes like 98961 (2-4 patients), 98962 (5-8 patients), and 98966 (telephone assessment) exist for group sessions or telephone services.
PayerPrice provides national average reimbursement rates for CPT 98960 from major payers like United, Cigna, Aetna, and BCBS/Anthem, as well as provider-level rates. You can also view Medicare rates for 98960 through their platform. For specific fee schedules based on your location, PayerPrice offers a lookup tool where you can search with the CPT code and specific location.