Billing code 98968: Telephone managementMedicare rate & RVUs
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 $34.74 for 98968 nationally in the office and $29.06 in a hospital or facility. Local office rates run $33.14–$47.55.
Medicare rate · 98968
Telephone management
Swap in your local Medicare rate.
- Work RVUs
- 0.75
- Total RVUs
- 1.04
- Global days
- XXX
National rate · 2026
$34.74
Office setting, before claim adjustments.
See every locality for 98968 → · Billed by an NP, PA or therapist? →
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 10 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. CMS’s listed rules for this code specify no special add-on, global-period, component, or reduction treatment.
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
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$33.14 to $47.55
109 of 109 payment localities
98968 rates by state
Office rate range in each state. Select a state to see its payment localities.
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Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$33.14
$47.55
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $47.55 | 1 |
| AL | $33.32 | 1 |
| AR | $33.14 | 1 |
| AZ | $34.36 | 1 |
| CA | $35.72–$41.17 | 29 |
| CO | $35.47 | 1 |
| CT | $36.07 | 1 |
| DC | $37.77 | 1 |
| DE | $34.69 | 1 |
| FL | $34.68–$36.13 | 3 |
| GA | $33.89–$35.09 | 2 |
| GU | $35.69 | 1 |
| HI | $35.69 | 1 |
| IA | $33.57 | 1 |
| ID | $33.66 | 1 |
| IL | $34.33–$35.82 | 4 |
| IN | $33.74 | 1 |
| KS | $33.54 | 1 |
| KY | $33.68 | 1 |
| LA | $33.67–$34.30 | 2 |
| MA | $35.48–$37.44 | 2 |
| MD | $35.04–$37.77 | 3 |
| ME | $33.76–$34.41 | 2 |
| MI | $34.04–$34.88 | 2 |
| MN | $34.53 | 1 |
| MO | $33.48–$34.31 | 3 |
| MS | $33.31 | 1 |
| MT | $34.74 | 1 |
| NC | $33.89 | 1 |
| ND | $34.34 | 1 |
| NE | $33.63 | 1 |
| NH | $35.02 | 1 |
| NJ | $36.63–$37.80 | 2 |
| NM | $34.12 | 1 |
| NV | $34.63 | 1 |
| NY | $34.09–$38.62 | 5 |
| OH | $33.96 | 1 |
| OK | $33.62 | 1 |
| OR | $34.50–$35.97 | 2 |
| PA | $33.96–$35.69 | 2 |
| PR | $34.83 | 1 |
| RI | $35.44 | 1 |
| SC | $33.95 | 1 |
| SD | $34.29 | 1 |
| TN | $33.61 | 1 |
| TX | $33.88–$35.23 | 8 |
| UT | $34.13 | 1 |
| VA | $34.39–$37.77 | 2 |
| VI | $34.83 | 1 |
| VT | $34.32 | 1 |
| WA | $35.38–$37.91 | 2 |
| WI | $33.90 | 1 |
| WV | $33.84 | 1 |
| WY | $34.56 | 1 |
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
Swap in your local Medicare rate.
Work 0.75Practice expense 0.27Malpractice 0.02
All indexes start 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).
Non-facility (office) rate · national
$34.74
The facility rate would be $29.06 (+$5.68). In a facility, the facility bills its own costs separately.
98968 compared with similar codes
Compare codes
98968 vs 98967 vs 98966 vs 98970 vs 98960: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 98967Telephone assessment
- Both describe telephone assessment and management by a qualified nonphysician professional. Choose 98967 for 11–20 minutes and 98968 for 21–30 minutes.
- 98966Telephone assessment
- This is the same telephone service at the 5–10-minute level; 98968 requires 21–30 minutes.
- 98970Digital assessment
- This code family covers online digital assessment and management, not a live telephone discussion.
- 98960Edu&trn pt self-mgmt nqhp 1
- 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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