CPT code 98960: Self-management training, individual, per 30 minutes2026 Medicare rate & RVUs in Guam
Reports 30 minutes of face-to-face, individualized self-management education by a qualified nonphysician professional using a standardized curriculum.
CMS doesn’t publish an office rate for 98960 in Guam.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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What 98960 covers
This service covers individualized, face-to-face education that helps a patient develop skills to manage a health condition. A qualified nonphysician health care professional uses a standardized curriculum; a nurse, dietitian, or pharmacist may provide the training when qualified. The patient is trained individually, though a caregiver or family member may participate. Examples include instruction on managing a chronic condition, following a care plan, or using self-management techniques in daily life.
CPT 98960 represents each 30 minutes of this individual training. Medicare assigns it physician fee schedule status B, meaning Medicare never pays it separately; its payment is included in payment for other services. The code is distinct from the related group-training codes, which are selected according to the number of patients trained together. Document the patient’s participation, training content, curriculum, and time spent so the individual service and its units are clear.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
98960 in Hawaii, Guam, HI
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam, HI | Unavailable | Unavailable |
How the 98960 rate is calculated
Each of 98960’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 98960
RVUs × geographic indexes × conversion factor
Work0.00
0.00 RVUs× 1.000 GPCI
Practice expense0.98
0.98 RVUs× 1.000 GPCI
Malpractice0.02
0.02 RVUs× 1.000 GPCI
Adjusted RVUs
1.0000
Conversion factor
$33.4009
Medicare rate
$33.40
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 98960
98960 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.
Place of service · 98960
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
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98960 isn’t priced in this setting.
98960 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 98961Self-management education2-4 patients
- 98960 is for one patient; 98961 is for self-management training delivered to a group of 2–4 patients.
- 98962Self-management trainingGroup of 5-8
- 98960 is for one patient; 98962 applies when the training group has 5–8 patients.
- G0108Diabetes trainingIndividual, per 30 minutes
- G0108 identifies individual diabetes self-management training; 98960 describes individualized self-management training more generally.
- 98970Digital assessmentQualified nonphysician, 5–10 minutes
- 98970 describes online digital assessment and management by a qualified professional, not face-to-face education using a standardized self-management curriculum.
98960 billing questions
When should I use 98960 instead of 98961 or 98962?
Use 98960 for training provided to one patient. Codes 98961 and 98962 describe group training, with the applicable code determined by group size.
How many units does 98960 represent?
Each unit represents 30 minutes of individual training. Document the time spent on the service.
Can a caregiver participate in the training?
Yes. A caregiver or family member may participate while the education is directed to the individual patient.
Does Medicare pay 98960 separately?
No. Medicare assigns status B: payment for this code is included in payment for other services, and Medicare never pays it separately.
What should the record support?
Document the individual training, the standardized curriculum and topics covered, the patient’s participation, and the time spent.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
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