How much does Medicare pay for CPT 98968?

Medicare allowed an average of $29.87 per service and paid $22.80 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $76.05, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 98968?

Telephone medical discussion provided by nonphysician professional, 21-30 minutes. It was billed 4,969 times to 2,088 Medicare beneficiaries by 81 providers in 2024.

Does 98968 pay differently in an office than a hospital?

Yes. The allowed amount averaged $29.97 in an office setting and $26.08 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 98968 most?

Internal Medicine, with 1,567 services from 7 clinicians. Next are Nurse Practitioner, Licensed Clinical Social Worker, Family Practice.

CPT 98968

Telephone medical discussion provided by nonphysician professional, 21-30 minutes

$29.87Medicare-allowed amount per service, averaged across 4,969 services

Providers submitted

$76.05

Asking price, not received

Medicare allowed

$29.87

The fee schedule figure

Medicare paid

$22.80

Balance is patient coinsurance

Providers submitted an average of $76.05 for this code and Medicare allowed $29.87 — 2.5× 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 $22.80 (76%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $29.97
Hospital / facility: $26.08

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. 4,838 services were billed in an office setting and 131 in a facility.

Services: 4,969
Beneficiaries: 2,088
Providers billing it: 81
Total allowed: $148,424

What Medicare pays for CPT 98968

Across 4,969 services billed by 81 providers to 2,088 beneficiaries, Medicare allowed an average of $29.87 per service. That is 2.4 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 98968

Specialty	Services	Beneficiaries	Avg allowed	Providers
Internal Medicine	1,567	165	$31.10	7
Nurse Practitioner	699	516	$28.33	22
Licensed Clinical Social Worker	601	112	$24.40	6
Family Practice	354	223	$34.30	5
Physician Assistant	325	292	$29.97	6
Urology	312	297	$32.95	7
Psychologist, Clinical	275	37	$33.59	3
Registered Dietitian or Nutrition Professional	238	145	$28.47	8
Marriage and Family Therapist	230	15	$25.12	1
Licensed Professional Counselor	71	19	$24.09	1
Physical Therapist in Private Practice	46	46	$32.65	2
Audiologist	39	31	$33.30	2
Gastroenterology	33	32	$35.30	2
Gynecological Oncology	31	31	$31.60	1
Psychiatry	27	16	$29.88	1

98968 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
Mississippi	1,465	$31.03	$25.73	2
California	1,394	$29.41	$20.83	21
Pennsylvania	342	$32.82	$24.19	9
New York	264	$24.64	$16.85	3
Florida	224	$27.59	$20.51	5
Louisiana	194	$33.10	$25.80	1
Texas	177	$27.48	$22.01	6
Oregon	118	$25.92	$20.45	3
Massachusetts	86	$29.50	$23.54	1
North Carolina	69	$30.97	$22.68	3
Georgia	68	$30.42	$25.12	4
District of Columbia	67	$35.51	$21.25	2
Washington	65	$31.73	$25.24	2
New Hampshire	62	$29.57	$21.02	1
Maryland	57	$31.47	$19.81	3
Kansas	36	$27.12	$20.73	1
Connecticut	35	$28.64	$20.66	2
Illinois	29	$33.30	$22.16	1
South Carolina	27	$29.88	$24.88	1
Virginia	25	$24.05	$17.02	1
Missouri	23	$27.27	$21.96	1
Maine	21	$27.64	$23.74	1
Nebraska	20	$26.60	$24.84	1
Arkansas	20	$26.29	$23.68	1
Minnesota	19	$27.45	$25.19	1
Arizona	17	$32.09	$25.79	1
Ohio	16	$22.22	$17.95	1
Michigan	16	$27.98	$20.59	1
Alabama	13	$31.09	$22.05	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.