$13.22–$13.96
Use 98966 for a qualifying telephone assessment and management service by a qualified nonphysician professional. Use 98970 for the online digital service.
On this page
CMS RVU26D · Effective 2026-10-01
98970 Digital assessment Medicare reimbursement rates in Texas
Reports a qualified nonphysician clinician’s online assessment and management of an established patient’s concern when cumulative service time is 5–10 minutes. Compare 98970 office and facility rates across CMS payment localities in Texas.
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 98970 in Texas?
Texas has 8 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 8 payment areas shown below, using the same CMS release.
Office / nonfacility
$12.00–$12.55
8 of 8 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.
Where 98970 pays more and less in Texas
8 payment localities
$12.00 to $12.55
Online digital care
About 98970: Established patient online digital assessment
Reports a qualified nonphysician clinician’s online assessment and management of an established patient’s concern when cumulative service time is 5–10 minutes.
A qualified nonphysician health care professional uses an online digital exchange to assess and manage a clinical concern raised by an established patient. The exchange may include reviewing the patient’s symptoms or records, evaluating the issue, and sending clinical guidance or arranging follow-up. A physical therapist, occupational therapist, or other qualified clinician may report the service when it falls within the professional’s scope. Routine scheduling, refill routing, and other administrative portal traffic are not clinical assessment and management.
Select this level when the professional’s cumulative time for the online service over the 7-day period is 5–10 minutes; the related levels cover longer time. The record should show the patient’s concern, the digital interaction, the clinical assessment and response, and the time accumulated during the period. The service is for an established patient and is distinct from telephone assessment and management, which uses the telephone-service code family.
Where the value comes from
- Work RVU0.25 · 68%
- Practice expense (office) RVU0.11 · 30%
- Malpractice RVU0.01 · 3%
435
Medicare services in 2024 · #3668 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.
98970 compared with similar codes
Office rates for Texas, from the same CMS release.
$22.31–$23.45
Both codes cover online digital assessment and management by a qualified nonphysician professional; select 98971 when cumulative time reaches its longer time level.
98960
No office rateEdu&trn pt self-mgmt nqhp 1
98960 describes individual patient self-management education and training. 98970 is for online clinical assessment and management of an established patient’s concern.
Compare 98970 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.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | Office $12.55 | Facility $10.43 |
| Beaumont | Office $12.00 | Facility $10.18 |
| Brazoria | Office $12.32 | Facility $10.33 |
| Dallas | Office $12.37 | Facility $10.38 |
| Fort Worth | Office $12.34 | Facility $10.36 |
| Galveston | Office $12.34 | Facility $10.35 |
| Houston | Office $12.53 | Facility $10.53 |
| Rest Of Texas | Office $12.14 | Facility $10.24 |
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98970 billing questions
How is 98970 distinguished from 98971 and 98972?
Choose among these online digital service levels by the qualified professional’s cumulative time over the 7-day period. 98970 covers 5–10 minutes; 98971 and 98972 represent the longer time levels.
Can a phone call count toward 98970?
No. 98970 describes online digital assessment and management; telephone assessment and management by a qualified nonphysician professional is reported from 98966–98968 when applicable.
What documentation supports reporting this service?
Document the established patient’s clinical concern, the online exchange and clinical response, and the professional’s cumulative time for the 7-day period.
Do routine portal messages qualify?
No. Scheduling, administrative requests, and messages without clinical assessment and management do not describe this service.
Can the digital work be separately reported when it leads to an office visit?
When the digital assessment is related to an E/M service in the preceding 7 days or leads to an E/M service within 24 hours or the soonest available appointment, the work is included in that E/M 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 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.
12,94998966,,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
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