CPT 98968 Other
Ph1 assmt&mgmt nqhp 21-30 Cost
Body System: General
Medicare Facility Rate
$29
CMS PFS CY2026
Medicare Non-Facility Rate
$35
Office/clinic setting
Relative Value Units (RVUs)
Medicare payment = Total RVU × Conversion Factor ($33.40 for CY 2026)
0.75
Work RVU
0.10
Facility PE RVU
0.02
Malpractice RVU
1.04
Total RVU
Cost by Location
| Location | Medicare Rate | Est. Commercial |
|---|---|---|
| AK — ALASKA | $42 | $62 — $96 |
| AL — ALABAMA | $28 | $44 — $67 |
| AR — ARKANSAS | $28 | $43 — $67 |
| AZ — ARIZONA | $29 | $45 — $69 |
| CA — BAKERSFIELD | $30 | $47 — $72 |
| CA — CHICO | $30 | $47 — $72 |
| CA — EL CENTRO | $30 | $47 — $72 |
| CA — FRESNO | $30 | $47 — $72 |
| CA — HANFORD-CORCORAN | $30 | $47 — $72 |
| CA — LOS ANGELES-LONG BEACH-ANAHEIM (LOS ANGELES/ORANGE CNTY) | $31 | $49 — $75 |
| CA — MADERA | $30 | $47 — $72 |
| CA — MERCED | $30 | $47 — $72 |
| CA — MODESTO | $30 | $47 — $72 |
| CA — NAPA | $32 | $51 — $78 |
| CA — OXNARD-THOUSAND OAKS-VENTURA | $30 | $48 — $74 |
| CA — REDDING | $30 | $47 — $72 |
| CA — REST OF CALIFORNIA | $30 | $47 — $72 |
| CA — RIVERSIDE-SAN BERNARDINO-ONTARIO | $30 | $47 — $72 |
| CA — SACRAMENTO-ROSEVILLE-FOLSOM | $30 | $48 — $74 |
| CA — SALINAS | $30 | $48 — $74 |
Frequently Asked Questions
How much does Ph1 assmt&mgmt nqhp 21-30 cost?
The Medicare facility rate is $29. Commercial insurance typically pays 150-250% of Medicare rates (varies).
How much does Ph1 assmt&mgmt nqhp 21-30 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 $29.