CPT stands for Current Procedural Terminology. CPT codes are a set of medical codes used by physicians, allied health professionals, and hospitals to describe the medical, surgical, and diagnostic services they provide to patients. These codes are essential for accurate medical billing and to ensure healthcare providers are reimbursed correctly by insurance companies.

How can I find the cost of a specific medical procedure or service in my area?

To find the cost of a specific medical procedure or service, you can use online tools that provide fee schedule lookups. For an accurate estimate based on a CPT code and your specific location, you can utilize tools like Payerprice. Payerprice offers a fee schedule lookup tool that allows users to search with a CPT code and specific location to get an idea of potential costs. You can also contact your insurance provider directly or the healthcare facility where you plan to receive services for estimates, but these may not always be as granular as a dedicated lookup tool.

What factors influence the cost of medical services?

Several factors can influence the cost of medical services, including: * **Geographic location:** Costs can vary significantly from one city or state to another. * **Provider's fees:** Different doctors, hospitals, and clinics may charge different amounts for the same service. * **Insurance plan:** Your insurance plan's negotiated rates, deductible, copay, and coinsurance will impact your out-of-pocket costs. * **Facility type:** Services performed in a hospital outpatient setting often cost more than those performed in an independent physician's office or ambulatory surgery center. * **Complexity of the procedure:** More complex procedures naturally incur higher costs. * **Additional services:** Costs can increase if additional tests, consultations, or follow-up care are needed.

What is an Explanation of Benefits (EOB)?

An Explanation of Benefits (EOB) is a statement sent by your health insurance company after you receive medical care. It's not a bill, but rather a summary of the services you received, how much your provider charged, what your insurance covered, and what amount you may still owe (your patient responsibility). It details things like the amount billed, the allowed amount, the amount paid by the insurer, and your deductible, copay, or coinsurance responsibilities.

CPT 98968 Fee Schedule

Last Verified: September 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 21 30 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 21 30 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 None
Common Modifiers	None 95 - Telemedicine - audio and video 93 - Telemedicine - audio only
Complexity Level	Low
Medicare Fee Schedule	View Medicare rates for 98968
Medicaid Fee Schedule	View Medicaid rates for 98968

National average reimbursement for CPT 98968 by major payers:

$41.36

$49.64

$47.74

$66.24

Compare published rates across providers.

Choose a payer to see a sample of rates for CPT 98968.

CPT 98968

5 of 25 sample ratesHigher to lower in this preview

Courtney Romba
ILPsychiatry PhysicianNPI 1255696290Tax ID 36-4187449
$97.12Published rate
Maleeha Ahsan
Advocate Health And Hospitals Corporation
ILPsychiatry PhysicianNPI 1003869553Tax ID 36-2169147
$85.33Published rate
Aniruddha Deka
CTPsychiatry PhysicianNPI 1689166027Tax ID 91-1780160
$70.37Published rate
Sulaiman Farooqui
Advocate Health And Hospitals Corporation
ILPsychiatry PhysicianNPI 1558867523Tax ID 36-2169147
$52.54Published rate
Christopher Johnson
Southern Illinois Healthcare Foundation Inc
ILPsychiatry PhysicianNPI 1205975448Tax ID 37-1158318
$26.92Published rate

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Summit Women's CareDenver, Colorado

September 2, 2026

Contracting Manager
UnitedHealthcare
Commercial PPO

Re: Request for fee schedule renegotiation

We request a formal review of our Commercial PPO fee schedule. The comparison below summarizes our current rate alongside published rates for comparable Denver-area practices.

Market evidence · CPT 59485

Current rate: $152.40
Market median: $147.00
Market position: 61st percentile

The comparison includes 1,284 published rates from 96 provider groups, scoped to OB/GYN providers in a professional, office-based setting.

We would welcome a discussion of our fee schedule and the supporting July 2026 market analysis. Please let us know a suitable time to review the comparison together.

Sincerely,
Summit Women's Care

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CPT 98968 vs. Other Non-Face-to-Face Nonphysician Services Codes

The CPT 98968 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 98968 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
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
98968-CPT	Low	Hc Pro Phone Call 21 30 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 21 30 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 98968. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 98968 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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CPT 98968 Fee Schedule

Compare published rates across providers.

Courtney Romba

Maleeha Ahsan

Aniruddha Deka

Sulaiman Farooqui

Christopher Johnson