Billing code 98970: Digital assessmentMedicare rate & RVUs
Reports a qualified nonphysician clinician’s online assessment and management of an established patient’s concern when cumulative service time is 5–10 minutes.
Medicare pays $12.36 for 98970 nationally in the office and $10.35 in a hospital or facility. Local office rates run $11.68–$16.62.
Medicare rate · 98970
Digital assessment
Swap in your local Medicare rate.
- Work RVUs
- 0.25
- Total RVUs
- 0.37
- Global days
- XXX
National rate · 2026
$12.36
Office setting, before claim adjustments.
See every locality for 98970 → · 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 98970 covers
A qualified nonphysician health care professional uses an online digital exchange to assess and manage a clinical concern raised by an established patient. The exchange may include reviewing the patient’s symptoms or records, evaluating the issue, and sending clinical guidance or arranging follow-up. A physical therapist, occupational therapist, or other qualified clinician may report the service when it falls within the professional’s scope. Routine scheduling, refill routing, and other administrative portal traffic are not clinical assessment and management.
Select this level when the professional’s cumulative time for the online service over the 7-day period is 5–10 minutes; the related levels cover longer time. The record should show the patient’s concern, the digital interaction, the clinical assessment and response, and the time accumulated during the period. The service is for an established patient and is distinct from telephone assessment and management, which uses the telephone-service code family.
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 98970 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
$11.68 to $16.62
109 of 109 payment localities
98970 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$11.68
$16.62
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 | $16.62 | 1 |
| AL | $11.75 | 1 |
| AR | $11.68 | 1 |
| AZ | $12.20 | 1 |
| CA | $12.70–$14.75 | 29 |
| CO | $12.62 | 1 |
| CT | $12.88 | 1 |
| DC | $13.50 | 1 |
| DE | $12.32 | 1 |
| FL | $12.36–$13.02 | 3 |
| GA | $12.03–$12.51 | 2 |
| GU | $12.72 | 1 |
| HI | $12.72 | 1 |
| IA | $11.84 | 1 |
| ID | $11.89 | 1 |
| IL | $12.23–$12.87 | 4 |
| IN | $11.92 | 1 |
| KS | $11.84 | 1 |
| KY | $11.92 | 1 |
| LA | $11.92–$12.19 | 2 |
| MA | $12.62–$13.38 | 2 |
| MD | $12.46–$13.50 | 3 |
| ME | $11.94–$12.20 | 2 |
| MI | $12.08–$12.46 | 2 |
| MN | $12.23 | 1 |
| MO | $11.84–$12.18 | 3 |
| MS | $11.76 | 1 |
| MT | $12.36 | 1 |
| NC | $11.99 | 1 |
| ND | $12.16 | 1 |
| NE | $11.87 | 1 |
| NH | $12.47 | 1 |
| NJ | $13.06–$13.49 | 2 |
| NM | $12.12 | 1 |
| NV | $12.31 | 1 |
| NY | $12.08–$13.87 | 5 |
| OH | $12.04 | 1 |
| OK | $11.89 | 1 |
| OR | $12.24–$12.81 | 2 |
| PA | $12.04–$12.72 | 2 |
| PR | $12.39 | 1 |
| RI | $12.60 | 1 |
| SC | $12.03 | 1 |
| SD | $12.14 | 1 |
| TN | $11.87 | 1 |
| TX | $12.00–$12.55 | 8 |
| UT | $12.10 | 1 |
| VA | $12.20–$13.50 | 2 |
| VI | $12.39 | 1 |
| VT | $12.16 | 1 |
| WA | $12.58–$13.55 | 2 |
| WI | $11.97 | 1 |
| WV | $12.02 | 1 |
| WY | $12.27 | 1 |
How the 98970 rate is calculated
Each of 98970’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 · 98970
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.25Practice expense 0.11Malpractice 0.01
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 98970
98970 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 · 98970
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
Non-facility (office) rate · national
$12.36
The facility rate would be $10.35 (+$2.01). In a facility, the facility bills its own costs separately.
98970 compared with similar codes
Compare codes
98970 vs 98966 vs 98971 vs 98960: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 98966Telephone assessment
- Use 98966 for a qualifying telephone assessment and management service by a qualified nonphysician professional. Use 98970 for the online digital service.
- 98971Digital assessment
- Both codes cover online digital assessment and management by a qualified nonphysician professional; select 98971 when cumulative time reaches its longer time level.
- 98960Edu&trn pt self-mgmt nqhp 1
- 98960 describes individual patient self-management education and training. 98970 is for online clinical assessment and management of an established patient’s concern.
98970 billing questions
How is 98970 distinguished from 98971 and 98972?
Choose among these online digital service levels by the qualified professional’s cumulative time over the 7-day period. 98970 covers 5–10 minutes; 98971 and 98972 represent the longer time levels.
Can a phone call count toward 98970?
No. 98970 describes online digital assessment and management; telephone assessment and management by a qualified nonphysician professional is reported from 98966–98968 when applicable.
What documentation supports reporting this service?
Document the established patient’s clinical concern, the online exchange and clinical response, and the professional’s cumulative time for the 7-day period.
Do routine portal messages qualify?
No. Scheduling, administrative requests, and messages without clinical assessment and management do not describe this service.
Can the digital work be separately reported when it leads to an office visit?
When the digital assessment is related to an E/M service in the preceding 7 days or leads to an E/M service within 24 hours or the soonest available appointment, the work is included in that E/M service.
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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