$14.52–$15.04
Choose 98966 for 5–10 minutes of medical discussion; 98967 requires 11–20 minutes.
On this page
CMS RVU26D · Effective 2026-10-01
98967 Telephone assessment Medicare reimbursement rates in New Jersey
Reports 11–20 minutes of medical discussion by a qualified nonphysician health care professional with an established patient, parent, or guardian by telephone. Compare 98967 office and facility rates across CMS payment localities in New Jersey.
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 98967 in New Jersey?
New Jersey 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
$26.49–$27.38
2 of 2 localities have a supported rate.
Facility setting
$21.02–$21.57
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.
Telephone services
About 98967: Established patient telephone assessment
Reports 11–20 minutes of medical discussion by a qualified nonphysician health care professional with an established patient, parent, or guardian by telephone.
This service covers a telephone medical discussion between a qualified nonphysician health care professional and an established patient, parent, or guardian. An NP or PA may use it to assess a change in symptoms, discuss a medication response, or address another clinical concern that can be managed by phone. It is a discussion service, not an online exchange or patient self-management education session.
Select 98967 when the medical discussion lasts 11–20 minutes; use the adjacent telephone codes for shorter or longer discussions. Document the recipient, clinical issue, assessment or management provided, and time spent in medical discussion. The CPT reporting criteria exclude a call that arises from a related assessment and management service in the prior 7 days or leads to an assessment and management service or procedure within 24 hours or the soonest available appointment. CMS PFS data assign work, practice-expense, and malpractice RVUs, with separate office and facility practice-expense inputs.
Where the value comes from
- Work RVU0.50 · 67%
- Practice expense (office) RVU0.23 · 31%
- Malpractice RVU0.02 · 3%
9.6K
Medicare services in 2024 · #1492 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.
98967 compared with similar codes
Office rates for New Jersey, from the same CMS release.
$36.63–$37.80
Choose 98968 when the medical discussion lasts 21–30 minutes; 98967 covers 11–20 minutes.
$24.41–$25.25
98971 describes online digital assessment and management time accumulated over 7 days, rather than a telephone discussion.
Compare 98967 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
Northern Nj →
Office / nonfacility
$27.38
Facility
$21.57
Rest Of New Jersey →
Office / nonfacility
$26.49
Facility
$21.02
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98967 billing questions
How much discussion time supports 98967?
Use 98967 for 11–20 minutes of medical discussion. Document the time and the clinical work performed during the call.
Can the call be reported with a related visit?
The CPT criteria exclude a call arising from a related assessment and management service within the preceding 7 days or leading to an assessment and management service or procedure within 24 hours or the soonest available appointment.
How does 98967 differ from 98971?
98967 describes a telephone medical discussion. 98971 is for an online digital assessment and management service, with time accumulated during a 7-day period.
What should the record include?
Document who participated, the patient’s clinical concern, the assessment or management provided, and the minutes of medical discussion.
Does the recipient need to be an established patient?
Yes. The service is for an established patient or the patient’s parent or guardian.
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.
12,94798961,,Edu&trn pt slf-mgmt nqhp 2-4,B,+,0.00,0.46,,0.46,NA,0.01,0.47,0.47,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
12,94898962,,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