Billing code 98972: Digital assessmentMedicare rate & RVUs in Maine
Reports an established patient's online digital assessment and management by a qualified nonphysician health care professional when cumulative service time reaches 21 minutes.
Medicare pays $33.20–$33.94 for 98972 in the office in Maine, from Rest Of Maine to Southern Maine. Which amount applies depends on the service address.
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 9 sections
What 98972 covers
A qualified nonphysician health care professional uses an asynchronous online exchange, such as a secure patient portal, to assess and manage an established patient's health concern. The work may include reviewing the patient's submitted information, evaluating the concern, and sending clinical guidance or a management plan. The code captures cumulative service time across a period of up to seven days, rather than a single face-to-face visit or telephone call.
Report 98972 when documented time for the online assessment and management reaches 21 minutes or more during that service period. The record should support the patient's concern, the online exchange, the clinical work performed, and the total time counted. CMS assigns 0.69 work RVU, 0.31 office practice-expense RVU or 0.15 facility practice-expense RVU, and 0.03 malpractice RVU. The CMS facts provided list no additional payment rules for this code.
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 98972 pays more and less in Maine
| Payment locality | Office | Facility |
|---|---|---|
| Rest Of Maine | $33.20 | $28.28 |
| Southern Maine | $33.94 | $28.64 |
How the 98972 rate is calculated
Each of 98972’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 · 98972
RVUs × geographic indexes × conversion factor
Work0.69
0.69 RVUs× 1.000 GPCI
Practice expense0.31
0.31 RVUs× 1.000 GPCI
Malpractice0.03
0.03 RVUs× 1.000 GPCI
Adjusted RVUs
1.0300
Conversion factor
$33.4009
Medicare rate
$34.40
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 98972
98972 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 · 98972
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$34.40
- Non-facility (office)
- $34.40
- Facility
- $29.06
Higher because the practice carries its own overhead.
98972 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 98970Digital assessment
- Both describe online digital assessment and management by a nonphysician professional. Choose 98970 for 5 to 10 minutes; 98972 requires at least 21 minutes.
- 98971Digital assessment
- 98971 covers 11 to 20 minutes of online digital assessment and management. Report 98972 when the documented cumulative time reaches 21 minutes or more.
- 98968Telephone management
- 98968 is for telephone assessment and management, with a 21-to-30-minute time range. Use 98972 for qualifying online digital service time.
98972 billing questions
When should 98972 be selected instead of 98971?
Use 98972 when cumulative online assessment and management time reaches 21 minutes or more during the service period. Code 98971 covers the shorter 11-to-20-minute level.
Can each portal message be billed separately?
No. Select the code using the cumulative qualifying time for the online service period, not the number of messages exchanged.
How is 98972 different from telephone code 98968?
98972 represents an online digital exchange. Code 98968 represents telephone assessment and management and uses a 21-to-30-minute time range.
What should the record show?
Document the established patient's concern, the online assessment and management performed, the relevant exchange, and the cumulative time supporting the 21-minute threshold.
Does 98972 describe a live video visit?
No. It describes assessment and management through an online digital exchange, not a synchronous video encounter.
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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