CPT 98962 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 • Education and Training for Patient Self-Management |
| Common Place of Service | • None • 11 - Office • 10 - Telehealth in Patient's Home |
| Common Modifiers | • None • 95 - Telemedicine - audio and video • U2 |
| Complexity Level | Low |
National average reimbursement for CPT 98962 by major payers:
$10.56
$10.40
$10.30
$14.47
| 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 98962 | ||||||
United | 98962 | $21.26 | 1891921367 - KAVITA THAKKAR | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | PA | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 98962 | $20.31 | 1437298361 - ALIYA HAFEEZ | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 98962 | $23.96 | 1891921367 - KAVITA THAKKAR | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | PA | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 98962 | $17.28 | 1992961643 - CYNTHIA GORDON | 815174138 - (IL) ILLINOIS PROFESSIONALS HEALTH PROGR | IL | Psychiatry Physician (2084P0800X) |
United | 98962 | $18.84 | 1326579756 - TONY TU | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IL | Psychiatry Physician (2084P0800X) |
United | 98962 | $19.69 | 1750451472 - POONAM JHA | 205734385 | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 98962 | $22.17 | 1568752665 - ANDREW KNOX | 390884478 - BELLIN MEMORIAL HOSPITAL INC | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 98962 | $18.84 | 1548279870 - VINOD ALLURI | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IL | Psychiatry Physician (2084P0800X) |
United | 98962 | $18.84 | 1306340880 - GEORGE GIANAKAKOS | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IL | Psychiatry Physician (2084P0800X) |
United | 98962 | $14.71 | 1609187467 - FARAAZ FAKIH | 363149833 - NORTHWESTERN MEMORIAL HEALTHCARE | MA | Psychiatry Physician (2084P0800X) |
United | 98962 | $15.81 | 1215258876 - DARA PUMPHREY-RUIZ | 581672987 - (IL) EDWARD HEALTH VENTURES | MA | Psychiatry Physician (2084P0800X) |
United | 98962 | $21.26 | 1518033836 - LURIE CHILDREN'S MEDICAL GROUP, LCMG SPECIALTY SERVICES | 205734385 | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 98962 | $15.81 | 1164682597 - LEKSHMI VENUGOPAL | 581672987 - (IL) EDWARD HEALTH VENTURES | IL | Psychiatry Physician (2084P0800X) |
United | 98962 | $15.47 | 1790181402 - SONAM VERMA | 364143823 - SIU PHYSICIANS & SURGEONS INC | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 98962 | $12.52 | 1871054817 - ERIC ZIMMERMAN | 376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS | IL | Psychiatry Physician (2084P0800X) |
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 98962 vs. Other Education and Training for Patient Self-Management Codes
The CPT 98962 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 98962 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 | 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 | 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 | 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 | 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& Management Service Provided Within The Previous Seven Days Nor Leading To An Assessment And Management Service Or Procedure Within The Next 24 Hoursor 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 98962. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 98962 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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