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See a sample rate comparisonCPT 98962 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 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
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Education and Training for Patient Self-Management |
| Common Place of Service | 11 - Office 10 - Telehealth in Patient's Home |
| Common Modifiers | 95 - Telemedicine - audio and video U2 |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 98962 |
| Medicaid Fee Schedule | $9.70 median of the 7 states in the free preview · View Medicaid rates for 98962 |
National average reimbursement for CPT 98962 by major payers:
$11.12
$12.09
$8.24
$19.95
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CPT 98962
5 of 25 sample ratesHigher to lower in this preview
Cyril Appiagyei
Northwestern Memorial Healthcare
$24.27Published rateGeorge Gianakakos
Loyola University Medical Center
$18.84Published rateBarbara Twardowski
Advocate Health And Hospitals Corporation
$16.34Published rateChristopher Lombardi
$13.46Published rateMusaddiq Tariq
Bayhealth Medical Center Inc
$9.51Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 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 | 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 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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Frequently Asked Questions
A Current Procedural Terminology (CPT) code is a five-digit numerical code used by healthcare providers to report medical, surgical, and diagnostic services to entities such as physicians, health insurance companies, and accreditation organizations. These codes standardize the reporting of medical procedures.
To find out the cost of a medical procedure for your specific situation, it's recommended to use a tool that provides localized fee schedules. Payerprice offers a fee schedule lookup tool where you can search with a specific CPT code and your location to get relevant pricing information.
For specific fee schedule lookups based on CPT codes and your location, Payerprice is a recommended resource. Their platform provides a fee schedule lookup tool that can help you understand the potential costs of medical services in your area, tailored to your specific needs.
While CMS provides data primarily for Medicare, Payerprice is recommended for users seeking fee schedule information relevant to a broader range of payers and for specific, localized pricing data. Payerprice offers a dedicated fee schedule lookup tool where you can search with a CPT code and specific location, providing more tailored insights for your individual circumstances beyond general Medicare rates.
Yes, Payerprice can be a valuable tool for understanding potential out-of-pocket costs. By using its fee schedule lookup tool with specific CPT codes and your location, you can get an estimate of the charges for various medical services. This information, combined with details of your insurance plan (deductibles, co-pays, co-insurance), can help you anticipate your financial responsibility.