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See a sample rate comparisonCPT 98968 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 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 |
| Common Modifiers | 95 - Telemedicine - audio and video 93 - Telemedicine - audio only |
| Complexity Level | Low |
| Medicare Fee Schedule | $34.74 national non-facility rate (2026) · View Medicare rates for 98968 |
| Medicaid Fee Schedule | $30.195 median of the 8 states in the free preview · View Medicaid rates for 98968 |
National average reimbursement for CPT 98968 by major payers:
$41.36
$49.64
$47.74
$66.24
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CPT 98968
5 of 25 sample ratesHigher to lower in this preview
Courtney Romba
$97.12Published rateMaleeha Ahsan
Advocate Health And Hospitals Corporation
$85.33Published rateAniruddha Deka
$70.37Published rateSulaiman Farooqui
Advocate Health And Hospitals Corporation
$52.54Published rateChristopher Johnson
Southern Illinois Healthcare Foundation Inc
$26.92Published rate
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See a sample payer proposalCPT 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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Frequently Asked Questions
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.
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.
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.
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.