CPT 98968
Global XXX ActivePh1 assmt&mgmt nqhp 21-30
CPT 98968 Billing & Documentation Guide
CPT code 98968 (Ph1 assmt&mgmt nqhp 21-30) is classified under Medicine/E&M with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.75, a non-facility practice expense RVU of 0.27, and a malpractice RVU of 0.02, a total non-facility RVU of 1.04 and facility RVU of 0.87. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $35.55, though rates vary from $33.14 to $47.55 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 98968, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 98968 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
No global period (E/M and other non-procedural services)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 98968 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 98968
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.75 | 0.75 |
| Practice Expense RVU | 0.27 | 0.1 |
| Malpractice RVU | 0.02 | 0.02 |
| Total RVU | 1.04 | 0.87 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 98968
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $36.98 | $30.26 | $35.72 - $41.17 | 29 |
| Florida | $35.4 | $29.7 | $34.68 - $36.13 | 3 |
| Georgia | $34.49 | $29.08 | $33.89 - $35.09 | 2 |
| Illinois | $35.13 | $29.64 | $34.33 - $35.82 | 4 |
| Michigan | $34.46 | $29.13 | $34.04 - $34.88 | 2 |
| North Carolina | $33.89 | $28.59 | $33.89 - $33.89 | 1 |
| New York | $37.21 | $30.87 | $34.09 - $38.62 | 5 |
| Ohio | $33.96 | $28.77 | $33.96 - $33.96 | 1 |
| Pennsylvania | $34.83 | $29.27 | $33.96 - $35.69 | 2 |
| Texas | $34.69 | $29.1 | $33.88 - $35.23 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 98968
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 98968 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 36591 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 36592 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 93792 | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 93793 | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 96523 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 98000 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 98004 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 99363 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 99364 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 99421 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
Frequently Asked Questions, CPT 98968
What does CPT code 98968 mean? +
CPT code 98968 represents: Ph1 assmt&mgmt nqhp 21-30. It's in the Medicine/E&M category with a global period of XXX.
What is the Medicare reimbursement for CPT 98968? +
The 2026 Medicare national average non-facility payment for CPT 98968 is $35.55. Rates range from $33.14 to $47.55 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 98968? +
Medicine section spans a wide range: therapy services use GP/GO/GN (PT/OT/SLP plans of care) and KX (above cap with documentation). Drug administration uses JW (waste) and JZ (no waste). Professional/technical split applies to some diagnostic codes.
What bundling edits apply to CPT 98968? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
Get the full PayerReady toolkit
Free access to CPT/ICD-10 lookup, denial appeals, fee comparator, and claim auditing with credentialing enrollment.
Start free →Run this code through our claim audit tool
Check NCCI bundling, MUE limits, and modifier logic before submission.
Try the auditor →Did this page help?
Quick signal so we know what to improve.
If you want a code reference page that doesn't exist yet, email coding@payerready.com.
Tell us what's missing or wrong: coding@payerready.com. We respond within 5 business days.
Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
Powered by 11K CPT · 98K ICD-10 · 860K MPFS rates · 4.5M NCCI edits · 9.5M NPIs. Our data methodology · About our coding team