98012
No office rateSynch audio-only est sf 10
98016 covers a brief 5-to-10-minute check-in; 98012 is an established-patient audio-only E/M service with its own service and time requirements.
On this page
CMS RVU26D · Effective 2026-10-01
98016 Virtual check-in Medicare reimbursement rates in Ohio
A physician or qualified health care professional reports this brief technology-based discussion with an established patient when it remains separate from a related visit. Compare 98016 office and facility rates across CMS payment localities in Ohio.
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 98016 in Ohio?
Ohio 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
$16.79
1 of 1 localities have a supported rate.
Payment area: Ohio
One mapped payment locality.
Facility setting
$12.83
1 of 1 localities have a supported rate.
Payment area: Ohio
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.
Telehealth service
About 98016: Brief established-patient virtual check-in
A physician or qualified health care professional reports this brief technology-based discussion with an established patient when it remains separate from a related visit.
This service covers a short medical discussion with an established patient using communication technology, such as a virtual check-in to address a new concern or determine whether an in-person evaluation is needed. It is performed by a physician or other qualified health care professional who can report evaluation and management services. The discussion must take 5 to 10 minutes and cannot be part of a related evaluation and management service from the prior 7 days or lead to an evaluation and management service or procedure within 24 hours or the soonest available appointment.
Report the code only when the documented communication meets those time and relationship criteria; record the issue discussed and the medical decision or advice given. A substantive evaluation and management encounter by synchronous audio or video is represented by the applicable telehealth E/M code instead. CMS assigns physician work, practice expense, and malpractice relative values to this service under the Physician Fee Schedule. The supplied CMS rules list no special payment instruction for this code.
Where the value comes from
- Work RVU0.30 · 58%
- Practice expense (office) RVU0.20 · 38%
- Malpractice RVU0.02 · 4%
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.
98016 compared with similar codes
Office rates for Ohio, from the same CMS release.
98004
No office rateSynch audio-video est sf 10
98016 is a brief technology-based discussion, while 98004 represents a synchronous audio-video E/M encounter for an established patient.
$15.12
98016 is a brief communication service; 99421 is for qualifying asynchronous online digital E/M accumulated over the applicable service period.
Compare 98016 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
Ohio →
Office / nonfacility
$16.79
Facility
$12.83
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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 98016 in Ohio.
PPRRVU2026_Oct_nonQPP.csv
12,936
- Code
- 98016
- Physician work
- 0.30
- Practice expense
- 0.20
- Malpractice
- 0.02
GPCI2026.csv
85
- Locality
- Ohio
- Physician work
- 1.000
- Practice expense
- 0.913
- Malpractice
- 1.008
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.30 | × 1.000 | 0.3000 |
| Practice expense | 0.20 | × 0.913 | 0.1826 |
| Malpractice | 0.02 | × 1.008 | 0.0202 |
| Total RVUs | 0.5028 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Ohio$16.79
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.3 | 1 |
| Practice expense | 0.2 | 0.913 |
| Malpractice | 0.02 | 1.008 |
(0.3 × 1 + 0.2 × 0.913 + 0.02 × 1.008) × $33.4009 = $16.79
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.3 | 1 |
| Practice expense | 0.07 | 0.913 |
| Malpractice | 0.02 | 1.008 |
(0.3 × 1 + 0.07 × 0.913 + 0.02 × 1.008) × $33.4009 = $12.83
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.
98016 billing questions
How does this differ from an established-patient audio-only E/M service?
98016 is for a 5-to-10-minute brief medical discussion. Use an audio-only E/M code when the encounter is a substantive E/M service that meets that code's requirements.
Can the check-in be billed when it leads to an office visit?
Do not report 98016 when it leads to an E/M service or procedure within the next 24 hours or the soonest available appointment.
Can it be billed after a related E/M visit?
No. The communication cannot originate from a related E/M service provided during the previous 7 days.
What time should the record support?
Document 5 to 10 minutes of medical discussion, along with the concern addressed and the advice or decision reached.
Is this code for a new patient?
No. The service is limited to an established patient.
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.
12,93398013,,Synch audio-only est low 20,I,+,1.20,0.70,,0.27,,0.07,1.97,1.54,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,93498014,,Synch audio-only est mod 30,I,+,1.75,1.00,,0.38,,0.11,2.86,2.24,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,93598015,,Synch audio-only est high 40,I,+,2.60,1.40,,0.57,,0.16,4.16,3.33,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,93698016,,Brief comunicaj tech-bsd svc,A,,0.30,0.20,,0.07,,0.02,0.52,0.39,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,93798925,,Osteopath manj 1-2 regions,A,,0.45,0.49,,0.11,,0.03,0.97,0.59,0,000,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,93898926,,Osteopath manj 3-4 regions,A,,0.69,0.65,,0.16,,0.04,1.38,0.89,0,000,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,93998927,,Osteopath manj 5-6 regions,A,,0.94,0.82,,0.20,,0.06,1.82,1.20,0,000,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
8213282,NY,99,REST OF NEW YORK,1.000,0.950,0.703
8311502,NC,00,NORTH CAROLINA,1.000,0.933,0.639
8403302,ND,01,NORTH DAKOTA**,1.000,1.000,0.406
8515202,OH,00,OHIO,1.000,0.913,1.008
8604312,OK,00,OKLAHOMA,1.000,0.893,0.777
8702302,OR,01,PORTLAND,1.016,1.111,0.744
8802302,OR,99,REST OF OREGON,1.000,0.996,0.703