Billing code 98966: Telephone assessmentMedicare rate & RVUs

Medicare pays $13.69 for 98966 nationally in the office and $10.35 in a hospital or facility. Local office rates run $12.83–$18.05.

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

What 98966 covers

This code describes a brief telephone conversation in which a nonphysician qualified health care professional assesses and manages a clinical concern for an established patient, or the patient’s parent or guardian. A nurse practitioner or physician assistant might use it to address a symptom question or discuss a care issue that can be managed by phone. The service involves clinical judgment, not simply scheduling, relaying a routine message, or providing administrative information. It is a telephone service, not an exchange through an online patient portal.

Select this level when the documented service time is 5 through 10 minutes; use the longer time levels when the conversation meets their thresholds. The record should identify the concern, the assessment or management provided, and the time spent. billing code reporting conditions also require that the call not arise from a related assessment and management service in the previous seven days or lead to a related service or procedure within the next 24 hours or soonest available appointment. CMS assigns work, practice-expense, and malpractice values, with separate office and facility practice-expense inputs.

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 98966 pays more and less

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

109 of 109 payment localities

98966 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 98966 rate is calculated

Each of 98966’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 98966

98966 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.

98966 compared with similar codes

How to choose

98967Telephone assessment

Choose 98967 when the telephone assessment and management service takes 11–20 minutes; 98966 is the 5–10 minute level.

98968Telephone management

Choose 98968 for a telephone service of 21 minutes or more. 98966 covers the shorter 5–10 minute level.

98970Digital assessment

98970 describes online digital assessment and management, not a telephone conversation; its time level is 5–10 minutes.

98960Edu&trn pt self-mgmt nqhp 1

98960 is individual patient self-management education and training. Use 98966 for a qualifying brief telephone assessment and management service.

Codes related to 98966

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