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See a sample rate comparisonCPT 98966 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.
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
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Non-Face-to-Face Nonphysician Services |
| Common Place of Service | 11 - Office 19 - Off Campus Outpatient Hospital |
| Common Modifiers | 95 - Telemedicine - audio and video 93 - Telemedicine - audio only |
| Complexity Level | Low |
| Medicare Fee Schedule | $13.69 national non-facility rate (2026) · View Medicare rates for 98966 |
| Medicaid Fee Schedule | $11.255 median of the 8 states in the free preview · View Medicaid rates for 98966 |
National average reimbursement for CPT 98966 by major payers:
$16.47
$17.59
$17.37
$30.60
Compare published rates across providers.
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CPT 98966
5 of 25 sample ratesHigher to lower in this preview
Trilok Shah
Ascension Medical Group-Fox Valley Wisconsin Inc
$45.34Published rateAnita Pairitz
Loyola University Medical Center
$27.72Published rateMatthew Niedzwiecki
Loyola University Medical Center
$22.98Published rateBaycare Home Care, Inc.
Baycare Home Care Inc
$17.10Published rateNidhi Mehta
Town Center Orthopaedic Associates, P.C.
$12.76Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 98966 vs. Other Non-Face-to-Face Nonphysician Services Codes
The CPT 98966 code is part of the Medicine Services and Procedures services used for Non-Face-to-Face Nonphysician Services. 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 98966 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 98966. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 98966 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 98966 reports a 5 to 10 minute telephone assessment and management service by a qualified nonphysician health care professional, such as a therapist, for an established patient.
It is not reported if the call relates to a service in the previous 7 days or leads to a visit or procedure within the next 24 hours or the soonest available appointment. Longer calls use 98967 and 98968.
Medicare pays CPT 98966 under the Physician Fee Schedule. The non-facility rate applies when the service is done in an office and covers the practice's staff, supplies and equipment; the lower facility rate applies in a hospital or surgery center, which bills its own facility fee. Both are adjusted for the local cost of practice. Commercial payers negotiate their own rates, often as a percentage of Medicare, so the same code can pay very differently from one contract to the next.
This page lists the rates commercial payers have published for CPT 98966 in their Transparency in Coverage files, so you can compare payers and see where a contract falls. For government benchmarks, PayerPrice also has the Medicare fee schedule lookup and Medicaid fee schedules by state.