CPT 98967 Other
Ph1 assmt&mgmt nqhp 11-20 Cost
Body System: General
Medicare Facility Rate
$20
CMS PFS CY2026
Medicare Non-Facility Rate
$25
Office/clinic setting
Relative Value Units (RVUs)
Medicare payment = Total RVU × Conversion Factor ($33.40 for CY 2026)
0.50
Work RVU
0.08
Facility PE RVU
0.02
Malpractice RVU
0.75
Total RVU
Cost by Location
| Location | Medicare Rate | Est. Commercial |
|---|---|---|
| AK — ALASKA | $28 | $44 — $68 |
| AL — ALABAMA | $20 | $31 — $48 |
| AR — ARKANSAS | $19 | $31 — $48 |
| AZ — ARIZONA | $20 | $32 — $50 |
| CA — BAKERSFIELD | $20 | $34 — $52 |
| CA — CHICO | $20 | $34 — $52 |
| CA — EL CENTRO | $20 | $34 — $52 |
| CA — FRESNO | $20 | $34 — $52 |
| CA — HANFORD-CORCORAN | $20 | $34 — $52 |
| CA — LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) | $21 | $35 — $54 |
| CA — MADERA | $20 | $34 — $52 |
| CA — MERCED | $20 | $34 — $52 |
| CA — MODESTO | $20 | $34 — $52 |
| CA — NAPA | $22 | $37 — $57 |
| CA — OXNARD-THOUSAND OAKS-VENTURA | $21 | $35 — $54 |
| CA — REDDING | $20 | $34 — $52 |
| CA — REST OF CALIFORNIA | $20 | $34 — $52 |
| CA — RIVERSIDE-SAN BERNARDINO-ONTARIO | $21 | $34 — $52 |
| CA — SACRAMENTO-ROSEVILLE-FOLSOM | $21 | $35 — $53 |
| CA — SALINAS | $21 | $35 — $53 |
Frequently Asked Questions
How much does Ph1 assmt&mgmt nqhp 11-20 cost?
The Medicare facility rate is $20. Commercial insurance typically pays 150-250% of Medicare rates (varies).
How much does Ph1 assmt&mgmt nqhp 11-20 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 $20.