Billing code 98016: Virtual check-inMedicare rate & RVUs in Virginia
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.
Medicare pays $17.06–$19.17 for 98016 in the office in Virginia, from Virginia to Dc + Md/Va Suburbs. 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 98016 covers
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.
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 98016 pays more and less in Virginia
| Payment locality | Office | Facility |
|---|---|---|
| Dc + Md/Va Suburbs | $19.17 | $14.06 |
| Virginia | $17.06 | $12.79 |
How the 98016 rate is calculated
Each of 98016’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 · 98016
RVUs × geographic indexes × conversion factor
Work0.30
0.30 RVUs× 1.000 GPCI
Practice expense0.20
0.20 RVUs× 1.000 GPCI
Malpractice0.02
0.02 RVUs× 1.000 GPCI
Adjusted RVUs
0.5200
Conversion factor
$33.4009
Medicare rate
$17.37
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 98016
98016 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 · 98016
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$17.37
- Non-facility (office)
- $17.37
- Facility
- $13.03
Higher because the practice carries its own overhead.
98016 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 98012Synch 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.
- 98004Synch 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.
- 99421Online E/M
- 98016 is a brief communication service; 99421 is for qualifying asynchronous online digital E/M accumulated over the applicable service period.
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 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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