CPT code 98962: Self-management training, group of 5-82026 Medicare rate & RVUs in Michigan
A qualified nonphysician health care professional reports face-to-face self-management training for a group of 5-8 patients, with each unit representing 30 minutes.
CMS doesn’t publish an office rate for 98962 in Michigan.
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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On this page 9 sections
What 98962 covers
This code describes face-to-face instruction that develops patients’ ability to manage a health condition, using a standardized curriculum. A qualified nonphysician health care professional leads the session for a group of 5-8 patients. The group-size distinction separates 98962 from individual training and the smaller-group service in the same series. It represents structured patient education rather than a telephone assessment or online digital management service.
Each unit represents 30 minutes of training. Medicare assigns this code physician fee schedule status B: Medicare never pays it separately, and its payment is included in payment for other services. The group count and training duration identify the service represented; records should support the training provided, its duration, the professional furnishing it, and the number of patients attending.
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 98962 pays more and less in Michigan
| Payment locality | Office | Facility |
|---|---|---|
| Detroit, MI | Unavailable | Unavailable |
| Rest of Michigan | Unavailable | Unavailable |
How the 98962 rate is calculated
Each of 98962’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 · 98962
RVUs × geographic indexes × conversion factor
Work0.00
0.00 RVUs× 1.000 GPCI
Practice expense0.35
0.35 RVUs× 1.000 GPCI
Malpractice0.01
0.01 RVUs× 1.000 GPCI
Adjusted RVUs
0.3600
Conversion factor
$33.4009
Medicare rate
$12.02
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 98962
98962 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 · 98962
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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98962 isn’t priced in this setting.
98962 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 98960Self-management trainingIndividual, per 30 minutes
- 98960 is for individual self-management training; 98962 is for groups of 5-8 patients.
- 98961Self-management education2-4 patients
- 98961 applies to groups of 2-4 patients. Select 98962 when the group has 5-8.
- 98966Telephone assessment5–10 minutes
- 98966 describes a nonphysician professional's telephone assessment and management service, not face-to-face group self-management training.
- 99078Group educationHealth education
- 99078 describes attendance at group health education sessions; 98962 is for structured self-management training for groups of 5-8.
98962 billing questions
When should 98962 be used instead of 98961?
Use 98962 for a group of 5-8 patients. Code 98961 is for a group of 2-4.
How many minutes does one unit represent?
Each unit represents 30 minutes of self-management training.
Can this code describe one-on-one instruction?
No. Code 98962 is for training provided to 5-8 patients; 98960 describes individual training.
What should the record support?
Document the self-management training, its duration, the qualified nonphysician professional who provided it, and the group size.
Does Medicare pay 98962 separately?
No. Medicare assigns status B: payment for this code is bundled into payment for other services.
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
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