Billing code 98966: Telephone assessmentMedicare rate & RVUs in Oregon
A nonphysician qualified health care professional reports this brief telephone service for clinical assessment and management of an established patient’s concern.
Medicare pays $13.58–$14.30 for 98966 in the office in Oregon, from Rest Of Oregon to Portland. 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 98966 covers
This code describes a brief telephone conversation in which a nonphysician qualified health care professional assesses and manages a clinical concern for an established patient, or the patient’s parent or guardian. A nurse practitioner or physician assistant might use it to address a symptom question or discuss a care issue that can be managed by phone. The service involves clinical judgment, not simply scheduling, relaying a routine message, or providing administrative information. It is a telephone service, not an exchange through an online patient portal.
Select this level when the documented service time is 5 through 10 minutes; use the longer time levels when the conversation meets their thresholds. The record should identify the concern, the assessment or management provided, and the time spent. billing code reporting conditions also require that the call not arise from a related assessment and management service in the previous seven days or lead to a related service or procedure within the next 24 hours or soonest available appointment. CMS assigns work, practice-expense, and malpractice values, with separate office and facility practice-expense inputs.
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 98966 pays more and less in Oregon
| Payment locality | Office | Facility |
|---|---|---|
| Portland | $14.30 | $10.59 |
| Rest Of Oregon | $13.58 | $10.25 |
How the 98966 rate is calculated
Each of 98966’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 · 98966
RVUs × geographic indexes × conversion factor
Work0.25
0.25 RVUs× 1.000 GPCI
Practice expense0.15
0.15 RVUs× 1.000 GPCI
Malpractice0.01
0.01 RVUs× 1.000 GPCI
Adjusted RVUs
0.4100
Conversion factor
$33.4009
Medicare rate
$13.69
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 98966
98966 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 · 98966
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$13.69
- Non-facility (office)
- $13.69
- Facility
- $10.35
Higher because the practice carries its own overhead.
98966 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 98967Telephone assessment
- Choose 98967 when the telephone assessment and management service takes 11–20 minutes; 98966 is the 5–10 minute level.
- 98968Telephone management
- Choose 98968 for a telephone service of 21 minutes or more. 98966 covers the shorter 5–10 minute level.
- 98970Digital assessment
- 98970 describes online digital assessment and management, not a telephone conversation; its time level is 5–10 minutes.
- 98960Edu&trn pt self-mgmt nqhp 1
- 98960 is individual patient self-management education and training. Use 98966 for a qualifying brief telephone assessment and management service.
98966 billing questions
When should 98966 be chosen over 98967 or 98968?
Use 98966 for 5–10 minutes of telephone assessment and management. The sibling codes describe longer services: 98967 for 11–20 minutes and 98968 for 21 minutes or more.
Does a routine callback qualify?
Not by itself. The call must include clinical assessment or management of an established patient’s concern; scheduling or relaying routine information is not the service described by this code.
What documentation supports the service?
Document the patient’s clinical concern, the assessment or management performed, and the service time. The record should also support the billing code conditions concerning related services in the preceding seven days and following 24 hours or soonest available appointment.
Can an online portal exchange be reported with 98966?
No. This code describes a telephone conversation. Online digital assessment and management has separate codes, including 98970–98972.
Is patient education the same service?
No. Codes 98960–98962 describe structured education and training for patient self-management, while 98966 describes a short telephone assessment and management service.
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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