$12.62–$13.38
Both describe online digital assessment and management by a nonphysician professional. Choose 98970 for 5 to 10 minutes; 98972 requires at least 21 minutes.
On this page
CMS RVU26D · Effective 2026-10-01
98972 Digital assessment Medicare reimbursement rates in Massachusetts
Reports an established patient's online digital assessment and management by a qualified nonphysician health care professional when cumulative service time reaches 21 minutes. Compare 98972 office and facility rates across CMS payment localities in Massachusetts.
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 98972 in Massachusetts?
Massachusetts has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
$35.12–$37.25
2 of 2 localities have a supported rate.
Facility setting
$29.49–$30.87
2 of 2 localities have a supported rate.
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.
Online digital care
About 98972: Online digital assessment, 21 or more minutes
Reports an established patient's online digital assessment and management by a qualified nonphysician health care professional when cumulative service time reaches 21 minutes.
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.
Where the value comes from
- Work RVU0.69 · 67%
- Practice expense (office) RVU0.31 · 30%
- Malpractice RVU0.03 · 3%
1.3K
Medicare services in 2024 · #2808 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.
98972 compared with similar codes
Office rates for Massachusetts, from the same CMS release.
$23.55–$25.07
98971 covers 11 to 20 minutes of online digital assessment and management. Report 98972 when the documented cumulative time reaches 21 minutes or more.
$35.48–$37.44
98968 is for telephone assessment and management, with a 21-to-30-minute time range. Use 98972 for qualifying online digital service time.
Compare 98972 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.
2 of 2 payment localities
Metropolitan Boston →
Office / nonfacility
$37.25
Facility
$30.87
Rest Of Massachusetts →
Office / nonfacility
$35.12
Facility
$29.49
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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 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.
12,95198968,,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
12,95598975,,Rtm 1st set-up&pt educaj eqp,A,,0.00,0.63,,0.63,NA,0.02,0.65,0.65,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,95698976,,Rtm dev sply resp sys 16-30d,A,,0.00,1.55,,1.55,NA,0.01,1.56,1.56,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,95798977,,Rtm dev sply mscskl 16-30 d,A,,0.00,1.53,,1.53,NA,0.01,1.54,1.54,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00