How much does Medicare pay for CPT 98967?

Medicare allowed an average of $21.50 per service and paid $15.73 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $66.34, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 98967?

Telephone medical discussion provided by nonphysician professional, 11-20 minutes. It was billed 3,412 times to 2,291 Medicare beneficiaries by 92 providers in 2024.

Does 98967 pay differently in an office than a hospital?

Yes. The allowed amount averaged $21.57 in an office setting and $18.35 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 98967 most?

Nurse Practitioner, with 1,004 services from 38 clinicians. Next are Psychologist, Clinical, Internal Medicine, Physician Assistant.

CPT 98967

Telephone medical discussion provided by nonphysician professional, 11-20 minutes

$21.50Medicare-allowed amount per service, averaged across 3,412 services

Providers submitted

$66.34

Asking price, not received

Medicare allowed

$21.50

The fee schedule figure

Medicare paid

$15.73

Balance is patient coinsurance

Providers submitted an average of $66.34 for this code and Medicare allowed $21.50 — 3.1× 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 $15.73 (73%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $21.57
Hospital / facility: $18.35

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. 3,335 services were billed in an office setting and 77 in a facility.

Services: 3,412
Beneficiaries: 2,291
Providers billing it: 92
Total allowed: $73,358

What Medicare pays for CPT 98967

Across 3,412 services billed by 92 providers to 2,291 beneficiaries, Medicare allowed an average of $21.50 per service. That is 1.5 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 98967

Specialty	Services	Beneficiaries	Avg allowed	Providers
Nurse Practitioner	1,004	868	$20.49	38
Psychologist, Clinical	425	186	$23.08	3
Internal Medicine	412	317	$24.02	10
Physician Assistant	351	287	$21.53	11
Licensed Clinical Social Worker	316	34	$18.38	2
Marriage and Family Therapist	231	15	$18.29	1
Family Practice	182	140	$23.33	4
Urology	115	103	$24.11	5
Registered Dietitian or Nutrition Professional	103	82	$19.69	5
Emergency Medicine	70	69	$24.10	1
Endocrinology	61	56	$23.08	3
Interventional Pain Management	35	34	$23.56	2
Physical Medicine and Rehabilitation	20	15	$24.06	1
Certified Clinical Nurse Specialist	19	19	$19.77	1
Obstetrics & Gynecology	16	16	$24.84	1

98967 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	1,066	$21.00	$14.20	24
Texas	305	$19.84	$15.20	6
Florida	287	$22.95	$16.88	8
Virginia	250	$20.78	$16.71	6
Louisiana	209	$24.05	$18.78	1
New York	208	$22.50	$15.05	4
Connecticut	136	$21.33	$14.55	3
Pennsylvania	124	$23.64	$16.52	5
Michigan	92	$20.09	$14.57	4
Illinois	90	$20.50	$14.72	4
Delaware	85	$23.58	$14.96	1
Arizona	79	$20.57	$13.60	3
Georgia	67	$21.58	$16.61	3
Arkansas	50	$18.94	$18.16	2
New Hampshire	47	$21.66	$15.19	1
Washington	44	$23.79	$18.76	2
Maryland	39	$23.33	$13.38	3
New Jersey	34	$22.42	$15.75	2
New Mexico	33	$23.11	$17.12	1
South Carolina	30	$19.45	$15.96	1
Montana	28	$20.40	$16.89	2
Oregon	27	$20.11	$18.19	1
Ohio	21	$19.57	$12.27	1
District of Columbia	17	$22.02	$12.22	1
Minnesota	16	$20.34	$15.98	1
Nevada	16	$18.39	$15.97	1
North Carolina	12	$21.88	$14.63	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.