CPT 98971 Fee Schedule
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.
| 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 | None 95 - Telemedicine - audio and video GP - Services delivered under an outpatient physical therapy plan of care |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 98971 |
| Medicaid Fee Schedule | View Medicaid rates for 98971 |
National average reimbursement for CPT 98971 by major payers:
$27.97
$26.51
$25.39
$43.33
CPT 98971 vs. Other Non-Face-to-Face Nonphysician Services Codes
The CPT 98971 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 98971 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 |
|---|---|---|
| 98970-CPT | Low | Qualified Nonphysician Health, Qualified Nonphysician Health Care Professional Online Digital Evaluation And Management Service For An Established Patient For Up To 7 Days Cumulative Time During The 7 Days 5-10 Minutes |
| 98971-CPT | Low | Qualified Nonphysician Health, Qualified Nonphysician Health Care Professional Online Digital Evaluation And Management Service For An Established Patient For Up To 7 Days Cumulative Time During The 7 Days 11-20 Minutes |
| 98972-CPT | Low | Qualified Nonphysician Health, Qualified Nonphysician Health Care Professional Online Digital Evaluation And Management Service For An Established Patient For Up To 7 Days Cumulative Time During The 7 Days 21 Or More Minutes |
| 98975-CPT | Low | Remote Therapeutic Monitoring, Remote Therapeutic Monitoring (Eg Respiratory System Status Musculoskeletal System Status Therapyadherence Therapy Response) Initial Set-Up And Patient Education On Use Of Equipment |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 98971. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 98971 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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