CPT 98980 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 • GP - Services delivered under an outpatient physical therapy plan of care • CQ - PT services by assistant |
| Complexity Level | Low |
National average reimbursement for CPT 98980 by major payers:
$58.01
$63.93
$58.66
$91.78
| 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 98980 | ||||||
United | 98980 | $85.55 | 1760429831 - BRUCE MADSEN | 930590581 - EYECARE ASSOCIATES PC | OR | Ophthalmology Physician (207W00000X) |
United | 98980 | $36.47 | 1851441505 - NORTHLAND IMAGING, LLC | 431946816 | MO | Radiology Clinic/Center (261QR0200X) |
United | 98980 | $61.68 | 1316936990 - EL PASO COUNTY HOSPITAL DISTRICT, UNIVERSITY MEDICAL CENTER OF EL PASO | 746000756 - (TX) EL PASO COUNTY HOSPITAL DISTRICT | TX | General Acute Care Hospital (282N00000X) |
United | 98980 | $71.44 | 1154370708 - SAN ANTONIO VAMC, KERRVILLE VAMC | 742112082 | TX | General Acute Care Hospital (282N00000X) |
United | 98980 | $68.15 | 1699768705 - GONZALES HEALTHCARE SYSTEMS | 741625013 | TX | General Acute Care Hospital (282N00000X) |
United | 98980 | $24.62 | 1649223645 - ST DAVIDS HEALTHCARE PARTNERSHIP LP LLP, ROUND ROCK MEDICAL CENTER | 743001674 - (TX) LONE STAR CIRCLE OF CARE | TX | General Acute Care Hospital (282N00000X) |
United | 98980 | $108.33 | 1730556259 - RAM SAHA | 541581185 - MCV ASSOCIATED PHYSICIANS | TX | General Acute Care Hospital (282N00000X) |
United | 98980 | $73.95 | 1457358103 - BELLVILLE HOSPITAL DISTRICT, BELLVILLE GENERAL HOSPITAL | 274005511 - BELLVILLE MEDICAL CENTER | TX | General Acute Care Hospital (282N00000X) |
United | 98980 | $33.66 | 1003192311 - EL CAMPO MEMORIAL HOSPITAL | 452750258 - (TX) EL CAMPO MEMORIAL HOSPITAL | TX | General Acute Care Hospital (282N00000X) |
United | 98980 | $46.72 | 1407191984 - BSA HOSPITAL LLC | 300754305 | TX | General Acute Care Hospital (282N00000X) |
United | 98980 | $42.77 | 1699768705 - GONZALES HEALTHCARE SYSTEMS | 741625013 | TX | General Acute Care Hospital (282N00000X) |
United | 98980 | $72.51 | 1972590602 - PALO PINTO COUNTY HOSPITAL DISTRICT, PALO PINTO GENERAL HOSPITAL | 751256948 | TX | General Acute Care Hospital (282N00000X) |
United | 98980 | $128.96 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | 98980 | $87.01 | 1356320873 - EAST TEXAS MEDICAL CENTER ATHENS | 751854562 - (TX) ETX SUCCESSOR ATHENS | TX | General Acute Care Hospital (282N00000X) |
United | 98980 | $71.94 | 1477516466 - SCOTT & WHITE MEMORIAL HOSPITAL, BAYLOR SCOTT & WHITE MEDICAL CENTER - TEMPLE | 742958277 - SCOTT & WHITE CLINIC | TX | General Acute Care Hospital (282N00000X) |
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 98980 vs. Other Non-Face-to-Face Nonphysician Services Codes
The CPT 98980 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 98980 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 |
| 98980-CPT | Low | Remote Therapeutic Monitoring Treatment Managementservices Physician Or Other Qualified Health Careprofessional Time In A Calendar Month Requiring Atleast One Interactive Communication With The Pa- Tient Or Caregiver During The Calendar Month; First 20 Minutes |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 98980. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 98980 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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