CPT 98966 Other
Ph1 assmt&mgmt nqhp 5-10 Cost
Body System: General
Medicare Facility Rate
$10
CMS PFS CY2026
Medicare Non-Facility Rate
$14
Office/clinic setting
Relative Value Units (RVUs)
Medicare payment = Total RVU × Conversion Factor ($33.40 for CY 2026)
0.25
Work RVU
0.05
Facility PE RVU
0.01
Malpractice RVU
0.41
Total RVU
Cost by Location
| Location | Medicare Rate | Est. Commercial |
|---|---|---|
| AK — ALASKA | $15 | $24 — $36 |
| AL — ALABAMA | $10 | $17 — $26 |
| AR — ARKANSAS | $10 | $17 — $26 |
| AZ — ARIZONA | $10 | $18 — $27 |
| CA — BAKERSFIELD | $11 | $19 — $29 |
| CA — CHICO | $11 | $19 — $28 |
| CA — EL CENTRO | $11 | $19 — $28 |
| CA — FRESNO | $11 | $19 — $28 |
| CA — HANFORD-CORCORAN | $11 | $19 — $28 |
| CA — LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) | $11 | $19 — $30 |
| CA — MADERA | $11 | $19 — $28 |
| CA — MERCED | $11 | $19 — $28 |
| CA — MODESTO | $11 | $19 — $28 |
| CA — NAPA | $11 | $20 — $31 |
| CA — OXNARD-THOUSAND OAKS-VENTURA | $11 | $19 — $30 |
| CA — REDDING | $11 | $19 — $28 |
| CA — REST OF CALIFORNIA | $11 | $19 — $28 |
| CA — RIVERSIDE-SAN BERNARDINO-ONTARIO | $11 | $19 — $29 |
| CA — SACRAMENTO-ROSEVILLE-FOLSOM | $11 | $19 — $29 |
| CA — SALINAS | $11 | $19 — $29 |
Frequently Asked Questions
How much does Ph1 assmt&mgmt nqhp 5-10 cost?
The Medicare facility rate is $10. Commercial insurance typically pays 150-250% of Medicare rates (varies).
How much does Ph1 assmt&mgmt nqhp 5-10 cost without insurance?
Without insurance, you may pay the hospital's chargemaster rate, which is often 300-500% of Medicare. Ask about cash-pay discounts — many facilities offer 20-40% off for self-pay patients. The Medicare baseline for this procedure is $10.