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See a sample rate comparisonCPT 98972 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.
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
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Non-Face-to-Face Nonphysician Services |
| Common Place of Service | None 11 - Office |
| Common Modifiers | None X2 - Continuous/focused services 76 - Repeat procedure by same physician |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 98972 |
| Medicaid Fee Schedule | View Medicaid rates for 98972 |
National average reimbursement for CPT 98972 by major payers:
$40.79
$41.40
$37.78
$58.71
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CPT 98972
5 of 25 sample ratesHigher to lower in this preview
Tracy Binius
Fairview Health Services
$99.25Published rateDavid Banayan
$61.29Published rateCabrini Sutherland
Surgical Specialists Of Charlotte, PA
$56.09Published rateMatthew Filippo
Advocate Health And Hospitals Corporation
$52.33Published rateLaron Phillips
Brightside Medical
$33.38Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 98972 vs. Other Non-Face-to-Face Nonphysician Services Codes
The CPT 98972 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 98972 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 98972. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 98972 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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