CPT 98978 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 • None • 99 - Other POS |
| Common Modifiers | • None • 95 - Telemedicine - audio and video • GT - Via interactive audio and video telecommunication systems |
| Complexity Level | Low |
National average reimbursement for CPT 98978 by major payers:
$62.38
$63.75
$50.80
$253.45
| 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 98978 | ||||||
United | 98978 | $92.69 | 1811298987 - ROSARIO COSME CRUZ | 911780160 | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 98978 | $153.35 | 1386969079 - ADAM WALLACE | 391678306 - AURORA MEDICAL GROUP INC | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 98978 | $86.09 | 1649610239 - MICHAEL BYRNE | 911780160 | IL | Psychiatry Physician (2084P0800X) |
United | 98978 | $105.30 | 1710244991 - ALBA PERGJIKA | 364187449 | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 98978 | $97.44 | 1114196995 - ANGELA GREEN | 910844563 | IL | Psychiatry Physician (2084P0800X) |
United | 98978 | $80.25 | 1336431667 - SURAYA KAWADRY | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | CA | Psychiatry Physician (2084P0800X) |
United | 98978 | $105.30 | 1013173699 - REBECCA O'DONNELL | 364187449 | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 98978 | $84.77 | 1740252972 - DAVID HSU | 363907436 - ROCKFORD HEALTH PHYSICIANS | WI | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 98978 | $75.58 | 1487841540 - CEZARY DUDZINSKI | 363149833 - NORTHWESTERN MEMORIAL HEALTHCARE | IL | Psychiatry Physician (2084P0800X) |
United | 98978 | $96.79 | 1033347125 - DAVID HANRAHAN | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | VA | Psychiatry Physician (2084P0800X) |
United | 98978 | $76.93 | 1265883375 - JOCELYN LORENZO | 274026658 | LA | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 98978 | $72.75 | 1790181402 - SONAM VERMA | 611661781 | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 98978 | $96.79 | 1710206545 - NEIL JARIWALA | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IL | Psychiatry Physician (2084P0800X) |
United | 98978 | $102.36 | 1699713347 - PAULA GEWARGES | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 98978 | $47.59 | 1720344229 - KERRY COOK | 541383504 - TOWN CENTER ORTHOPAEDIC ASSOCIATES, P.C. | VA | Medical Physician Assistant (363AM0700X) |
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 98978 vs. Other Non-Face-to-Face Nonphysician Services Codes
The CPT 98978 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 98978 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 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 |
| 98975-CPT | Low | Remote Therapeutic Monitoring (Eg, Respiratory System Status, Musculoskeletal System Status, Therapy Adherence, Therapy Response); Initial Set-Up And Patient Education On Use Of Equipment |
| 98976-CPT | Low | Remote Therapeutic Monitoring (Eg, Respiratory System Status, Musculoskeletal System Status, Therapy Adherence, Therapy Response); Device(S) Supply With Scheduled (Eg, Daily) Recording(S) And/Or Programmed Alert(S) Transmission To Monitor Respiratory System, Each 30 Days |
| 98978-CPT | Low | Remote Therapeutic Monitoring (Eg, Therapy Adherence, Therapy Response); Device(S) Supply With Scheduled (Eg, Daily) Recording(S) And/Or Programmed Alert(S) Transmission To Monitor Cognitive Behavioral Therapy, Each 30 Days |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 98978. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 98978 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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