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See a sample rate comparisonCPT 98967 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 11 20 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 11 20 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 10 - Telehealth in Patient's Home |
| Common Modifiers | 95 - Telemedicine - audio and video 93 - Telemedicine - audio only |
| Complexity Level | Low |
| Medicare Fee Schedule | $25.05 national non-facility rate (2026) · View Medicare rates for 98967 |
| Medicaid Fee Schedule | $21.30 median of the 8 states in the free preview · View Medicaid rates for 98967 |
National average reimbursement for CPT 98967 by major payers:
$29.54
$33.88
$33.10
$50.33
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CPT 98967
5 of 25 sample ratesHigher to lower in this preview
P. Daniel Le Grange
$154.24Published rateRita Yadava
Rita Yadava Mdsc
$58.95Published rateJamie Evans
$51.50Published rateKhondakar Hasanat
Northwestern Memorial Healthcare
$42.68Published rateLaron Phillips
Brightside Medical
$26.02Published rate
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See a sample payer proposalCPT 98967 vs. Other Non-Face-to-Face Nonphysician Services Codes
The CPT 98967 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 98967 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 |
| 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 |
| 98967-CPT | Low | Hc Pro Phone Call 11 20 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 11 20 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 98967. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 98967 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 standardized five-digit codes used by healthcare providers to describe medical, surgical, and diagnostic services to health insurance companies for proper billing and reimbursement. They ensure a uniform language for procedures and services among doctors, patients, and payers.
Finding the exact cost of a medical procedure can be complex due to varying factors like your insurance plan, location, and specific provider. For general price transparency, you can look at your insurance company's website or utilize online tools. To get a precise estimate for your specific CPT code and location, it's recommended to use a fee schedule lookup tool like Payerprice. They offer a tool where you can search with a CPT code and specific location to get detailed pricing information.
Medical procedure prices can vary significantly due to several factors, including the healthcare provider's negotiation power with insurers, geographic location (cost of living, competition), facility type (hospital vs. outpatient clinic), the patient's insurance plan, and whether the provider is in-network or out-of-network. Additionally, the specific services bundled into a procedure can differ.
Healthcare price transparency refers to efforts to make the costs of medical services more accessible and understandable to consumers. The goal is to empower patients to compare prices and make more informed decisions about their healthcare, potentially leading to lower costs and increased competition among providers. Regulations often require hospitals and insurers to publish standard charges and negotiated rates.
To get a personalized estimate for a specific medical procedure using its CPT code and your location, you should use a dedicated fee schedule lookup tool. Payerprice offers such a tool that allows users to search with a CPT code and specific location, providing them with more accurate and localized pricing information relevant to their situation. This is a great way to understand potential costs before a procedure.