How much does Medicare pay for CPT 98966?

Medicare allowed an average of $11.76 per service and paid $8.59 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $32.11, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 98966?

Telephone medical discussion provided by nonphysician professional, 5-10 minutes. It was billed 5,789 times to 3,696 Medicare beneficiaries by 132 providers in 2024.

Does 98966 pay differently in an office than a hospital?

Yes. The allowed amount averaged $11.81 in an office setting and $10.00 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 98966 most?

Physician Assistant, with 1,124 services from 16 clinicians. Next are Nurse Practitioner, Internal Medicine, Licensed Clinical Social Worker.

CPT 98966

Telephone medical discussion provided by nonphysician professional, 5-10 minutes

$11.76Medicare-allowed amount per service, averaged across 5,789 services

Providers submitted

$32.11

Asking price, not received

Medicare allowed

$11.76

The fee schedule figure

Medicare paid

$8.59

Balance is patient coinsurance

Providers submitted an average of $32.11 for this code and Medicare allowed $11.76 — 2.7× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $8.59 (73%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $11.81
Hospital / facility: $10.00

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 5,636 services were billed in an office setting and 153 in a facility.

Services: 5,789
Beneficiaries: 3,696
Providers billing it: 132
Total allowed: $68,079

What Medicare pays for CPT 98966

Across 5,789 services billed by 132 providers to 3,696 beneficiaries, Medicare allowed an average of $11.76 per service. That is 1.6 services per beneficiary, so this is a code patients typically receive more than once. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 98966

Specialty	Services	Beneficiaries	Avg allowed	Providers
Physician Assistant	1,124	829	$10.95	16
Nurse Practitioner	1,085	782	$10.87	35
Internal Medicine	1,050	761	$12.77	23
Licensed Clinical Social Worker	410	105	$9.78	6
Family Practice	400	340	$12.97	14
Allergy/ Immunology	252	14	$13.55	1
Marriage and Family Therapist	227	15	$9.87	1
Cardiology	226	170	$12.25	6
Psychologist, Clinical	216	26	$13.05	2
Urology	198	150	$13.24	7
Nephrology	86	67	$13.52	2
Geriatric Medicine	69	60	$12.68	1
Emergency Medicine	67	65	$13.01	1
Anesthesiology	51	47	$12.52	1
Registered Dietitian or Nutrition Professional	36	23	$10.54	2

98966 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
California	1,157	$11.38	$8.02	21
Florida	1,121	$12.47	$8.92	24
Texas	576	$11.93	$8.76	17
Washington	429	$11.22	$7.83	2
New Jersey	376	$13.54	$9.19	4
Michigan	283	$10.66	$7.85	10
Arkansas	249	$10.71	$7.99	5
New York	230	$11.93	$8.24	6
Louisiana	205	$13.11	$10.16	1
Pennsylvania	175	$11.69	$8.57	3
Illinois	107	$11.23	$7.43	2
Ohio	86	$11.69	$8.30	2
Maryland	85	$11.59	$7.78	3
Virginia	84	$11.13	$8.36	5
Georgia	69	$11.99	$9.19	2
Alabama	60	$12.13	$10.00	3
Tennessee	44	$9.66	$7.77	2
Missouri	41	$10.65	$8.20	2
New Hampshire	39	$11.82	$8.41	1
Arizona	39	$10.68	$8.64	1
Connecticut	36	$9.97	$7.30	2
Nevada	36	$11.33	$7.93	2
North Carolina	33	$11.61	$7.02	1
Montana	31	$12.67	$10.18	1
South Carolina	29	$12.32	$8.13	1
Vermont	27	$0.01	$0.01	1
District of Columbia	24	$14.12	$8.47	1
Oregon	24	$10.71	$10.17	1
New Mexico	23	$10.56	$6.82	1
U.S. Virgin Islands	19	$12.29	$9.09	1
Idaho	18	$12.18	$10.15	1
Kansas	12	$9.14	$6.94	1
Colorado	11	$13.08	$10.10	1
West Virginia	11	$12.30	$10.17	1

Related codes

98941Chiropractic manipulative treatment$38.12
98940Chiropractic manipulative treatment$26.75
98942Chiropractic manipulative treatment$49.84
98977Device supply$48.07
98976Device supply$48.79
98980Remote therapeutic monitoring treatment management services by physici$49.72
98929Osteopathic manipulative treatment$83.31
98928Osteopathic manipulative treatment$70.48
98926Osteopathic manipulative treatment$43.00
98927Osteopathic manipulative treatment$57.47
98981Remote therapeutic monitoring treatment management services by physici$38.72
98975Set-up and patient education for remote monitoring of therapy$20.19

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.