CPT code 98968: Telephone management, 21–30 minutes2026 Medicare rate & RVUs in Illinois
A qualified nonphysician health care professional reports this code for a 21–30-minute telephone assessment and management discussion with an established patient or representative.
Medicare pays $34.33–$35.82 for 98968 in the office in Illinois, from Rest of Illinois to Chicago, IL. Which amount applies depends on the service address.
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 98968 covers
A qualified nonphysician health care professional uses this service to assess a patient’s concern by telephone and provide management advice or direction. The discussion may involve the patient or, when appropriate, a parent or guardian. It is a live telephone conversation, such as discussing symptoms, a medication concern, or next steps for an established patient; it is not an online portal exchange or self-management education session.
Select this code when the qualifying telephone service lasts 21–30 minutes; use 98966 or 98967 for the shorter time levels. Document the clinical issue, the assessment and management discussed, who participated, and the time spent in the telephone service. The service must not arise from a related evaluation and management service in the preceding seven days or lead to a related evaluation and management service or procedure within the following 24 hours or soonest available appointment.
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 98968 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
4 payment localities
$34.33 to $35.82
| Payment locality | Office | Facility |
|---|---|---|
| Chicago, IL | $35.82 | $30.12 |
| East St. Louis, IL | $34.69 | $29.47 |
| Rest of Illinois | $34.33 | $29.14 |
| Suburban Chicago, IL | $35.67 | $29.84 |
How the 98968 rate is calculated
Each of 98968’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 · 98968
RVUs × geographic indexes × conversion factor
Work0.75
0.75 RVUs× 1.000 GPCI
Practice expense0.27
0.27 RVUs× 1.000 GPCI
Malpractice0.02
0.02 RVUs× 1.000 GPCI
Adjusted RVUs
1.0400
Conversion factor
$33.4009
Medicare rate
$34.74
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 98968
98968 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 · 98968
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$34.74
- Non-facility (office)
- $34.74
- Facility
- $29.06
Higher because the practice carries its own overhead.
98968 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 98967Telephone assessment11–20 minutes
- Both describe telephone assessment and management by a qualified nonphysician professional. Choose 98967 for 11–20 minutes and 98968 for 21–30 minutes.
- 98966Telephone assessment5–10 minutes
- This is the same telephone service at the 5–10-minute level; 98968 requires 21–30 minutes.
- 98970Digital assessmentQualified nonphysician, 5–10 minutes
- This code family covers online digital assessment and management, not a live telephone discussion.
- 98960Self-management trainingIndividual, per 30 minutes
- This code reports individual self-management education and training, not a telephone assessment and management service.
98968 billing questions
When should 98968 be selected instead of 98967?
Use 98968 for 21–30 minutes of qualifying telephone assessment and management. Code 98967 represents the 11–20-minute level.
Can the service be billed when a related office visit follows?
It is not separately reported when the telephone service leads to a related evaluation and management service or procedure within 24 hours or the soonest available appointment.
Does an online portal exchange qualify?
No. This code describes a telephone discussion; online digital assessment and management is represented by a different code family, including 98970–98972.
What should the record support?
Document the patient’s concern, the assessment and management provided, the participants, and 21–30 minutes spent on the telephone service.
Can a brief message or voicemail support 98968?
No. The service is a telephone assessment and management discussion, and the documented service time must meet the 21-minute minimum.
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
Show the CMS file lines behind this rate
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