$24.15
Both describe telephone assessment and management by a qualified nonphysician professional. Choose 98967 for 11–20 minutes and 98968 for 21–30 minutes.
On this page
CMS RVU26D · Effective 2026-10-01
98968 Telephone management Medicare reimbursement rates in Indiana
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. Compare 98968 office and facility rates across CMS payment localities in Indiana.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 98968 in Indiana?
Indiana has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$33.74
1 of 1 localities have a supported rate.
Payment area: Indiana
One mapped payment locality.
Facility setting
$28.47
1 of 1 localities have a supported rate.
Payment area: Indiana
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Telephone services
About 98968: Telephone assessment and management, 21–30 minutes
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.
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.
Where the value comes from
- Work RVU0.75 · 72%
- Practice expense (office) RVU0.27 · 26%
- Malpractice RVU0.02 · 2%
12.9K
Medicare services in 2024 · #1340 by national volume
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.
98968 compared with similar codes
Office rates for Indiana, from the same CMS release.
$13.16
This is the same telephone service at the 5–10-minute level; 98968 requires 21–30 minutes.
$11.92
This code family covers online digital assessment and management, not a live telephone discussion.
98960
No office rateEdu&trn pt self-mgmt nqhp 1
This code reports individual self-management education and training, not a telephone assessment and management service.
Compare 98968 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Indiana →
Office / nonfacility
$33.74
Facility
$28.47
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 98968 in Indiana.
PPRRVU2026_Oct_nonQPP.csv
12,951
- Code
- 98968
- Physician work
- 0.75
- Practice expense
- 0.27
- Malpractice
- 0.02
GPCI2026.csv
52
- Locality
- Indiana
- Physician work
- 1.000
- Practice expense
- 0.927
- Malpractice
- 0.486
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.75 | × 1.000 | 0.7500 |
| Practice expense | 0.27 | × 0.927 | 0.2503 |
| Malpractice | 0.02 | × 0.486 | 0.0097 |
| Total RVUs | 1.0100 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Indiana$33.74
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.75 | 1 |
| Practice expense | 0.27 | 0.927 |
| Malpractice | 0.02 | 0.486 |
(0.75 × 1 + 0.27 × 0.927 + 0.02 × 0.486) × $33.4009 = $33.74
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.75 | 1 |
| Practice expense | 0.1 | 0.927 |
| Malpractice | 0.02 | 0.486 |
(0.75 × 1 + 0.1 × 0.927 + 0.02 × 0.486) × $33.4009 = $28.47
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
12,94898962,,Edu&trn pt slf-mgmt nqhp 5-8,B,+,0.00,0.35,,0.35,NA,0.01,0.36,0.36,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
12,94998966,,Ph1 assmt&mgmt nqhp 5-10,A,,0.25,0.15,,0.05,,0.01,0.41,0.31,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,95098967,,Ph1 assmt&mgmt nqhp 11-20,A,,0.50,0.23,,0.08,,0.02,0.75,0.60,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,95198968,,Ph1 assmt&mgmt nqhp 21-30,A,,0.75,0.27,,0.10,,0.02,1.04,0.87,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,95298970,,Nqhp ol dig assmt&mgmt 5-10,A,,0.25,0.11,,0.05,,0.01,0.37,0.31,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,95398971,,Nqhp ol dig assmt&mgmt 11-20,A,,0.44,0.23,,0.11,,0.02,0.69,0.57,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,95498972,,Nqhp ol dig assmt&mgmt 21+,A,,0.69,0.31,,0.15,,0.03,1.03,0.87,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
4906102,IL,12,EAST ST. LOUIS,1.000,0.920,2.014
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772
5106102,IL,99,REST OF ILLINOIS,1.000,0.913,1.563
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915