CPT 98968 Fee Schedule

Last Verified: November 2025

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.

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;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

National average reimbursement for CPT 98968 by major payers:

$41.36

$49.64

$47.74

$66.38

Preview provider-level rates for...

For billing codeCPT 98968

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 98968
United	98968	$67.87	1629181037 - DUKE RUKTANONCHAI	742958277 - SCOTT & WHITE CLINIC	IL	Psychiatry Physician (2084P0800X)
United	98968	$79.09	1114196995 - ANGELA GREEN	364015560 - LOYOLA UNIVERSITY MEDICAL CENTER	IL	Psychiatry Physician (2084P0800X)
United	98968	$59.90	1609296714 - JOHN ZULUETA	376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS	IL	Psychiatry Physician (2084P0800X)
United	98968	$52.54	1558867523 - SULAIMAN FAROOQUI	362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION	IL	Psychiatry Physician (2084P0800X)
United	98968	$36.36	1285834440 - LARON PHILLIPS	842494027 - BRIGHTSIDE MEDICAL	IL	Psychiatry Physician (2084P0800X)
United	98968	$47.88	1881012235 - LAUREN PREST	910843135	MN	Psychiatry Physician (2084P0800X)
United	98968	$31.89	1013538636 - OYOYO SAWYER	208106540 - DISTRICT MEDICAL GROUP INC	IL	Psychiatry Physician (2084P0800X)
United	98968	$40.00	1801164967 - DA PEDIATRIC REHABILITATION	270939565 - (FL) DA PEDIATRIC REHABILITATION	FL	Home Health Agency (251E00000X)
United	98968	$72.52	1992961643 - CYNTHIA GORDON	815174138 - (IL) ILLINOIS PROFESSIONALS HEALTH PROGR	IL	Psychiatry Physician (2084P0800X)
United	98968	$50.75	1134236565 - WARREN KAMMERER	611549647 - (IL) WARREN KAMMERER MD SC	IL	Psychiatry Physician (2084P0800X)
United	98968	$33.22	1265883375 - JOCELYN LORENZO	726000821	IL	Neurology with Special Qualifications in Child Neurology Physician (2084N0402X)
United	98968	$143.05	1225211600 - JOHN MILLICHAP	800863895	CO	Neurology with Special Qualifications in Child Neurology Physician (2084N0402X)
United	98968	$79.33	1245252303 - MARY FAHRMEIER	910844563	WI	Psychiatry Physician (2084P0800X)
United	98968	$68.59	1497080584 - ELIZABETH HOMAN	362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION	MN	Psychiatry Physician (2084P0800X)
United	98968	$79.09	1710206545 - NEIL JARIWALA	364015560 - LOYOLA UNIVERSITY MEDICAL CENTER	TX	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 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	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
98968-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;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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