CPT code 98961: Self-management education, 2-4 patients2026 Medicare rate & RVUs in California

CMS doesn’t publish an office rate for 98961 in California.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 98961 covers

This code represents face-to-face education that helps patients manage a health condition or treatment. A qualified nonphysician health care professional provides the instruction to a group of two to four patients, using a standardized curriculum. The service may address practical skills such as carrying out a care plan or managing a chronic condition. It is distinct from a one-to-one teaching visit and from telephone or online assessment and management.

The code is reported in 30-minute units. Medicare assigns it physician fee schedule status B: the service is never paid separately, and its payment is included in payment for other services. For documentation, retain the education provided, the face-to-face time, and the group size to support the reported service and unit count.

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.

Where 98961 pays more and less in California

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

29 of 29 payment localities

How the 98961 rate is calculated

Each of 98961’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.

Payment rules and modifiers for 98961

98961 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.

98961 compared with similar codes

How to choose

98960Self-management trainingIndividual, per 30 minutes

Use 98960 when the face-to-face self-management education is provided to one patient; 98961 is for two to four patients.

98962Self-management trainingGroup of 5-8

Use 98962 for a group of five to eight patients. The two-to-four-patient group belongs to 98961.

98966Telephone assessment5–10 minutes

98966 describes telephone assessment and management, not face-to-face group teaching. It is selected by telephone service duration.

98970Digital assessmentQualified nonphysician, 5–10 minutes

98970 describes online digital assessment and management, not face-to-face group education.

Codes related to 98961

Related codes aren’t interchangeable: bill the code that matches the service performed.

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.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates