Billing code 98967: Telephone assessmentMedicare rate & RVUs

Medicare pays $25.05 for 98967 nationally in the office and $20.04 in a hospital or facility. Local office rates run $23.64–$33.60.

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

What 98967 covers

This service covers a telephone medical discussion between a qualified nonphysician health care professional and an established patient, parent, or guardian. An NP or PA may use it to assess a change in symptoms, discuss a medication response, or address another clinical concern that can be managed by phone. It is a discussion service, not an online exchange or patient self-management education session.

Select 98967 when the medical discussion lasts 11–20 minutes; use the adjacent telephone codes for shorter or longer discussions. Document the recipient, clinical issue, assessment or management provided, and time spent in medical discussion. The billing code reporting criteria exclude a call that arises from a related assessment and management service in the prior 7 days or leads to an assessment and management service or procedure within 24 hours or the soonest available appointment. CMS PFS data assign work, practice-expense, and malpractice RVUs, 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 98967 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

98967 rates by state

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

How the 98967 rate is calculated

Each of 98967’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 98967

98967 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.

98967 compared with similar codes

How to choose

98966Telephone assessment

Choose 98966 for 5–10 minutes of medical discussion; 98967 requires 11–20 minutes.

98968Telephone management

Choose 98968 when the medical discussion lasts 21–30 minutes; 98967 covers 11–20 minutes.

98971Digital assessment

98971 describes online digital assessment and management time accumulated over 7 days, rather than a telephone discussion.

Codes related to 98967

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