CPT 98970
Global XXX ActiveNqhp ol dig assmt&mgmt 5-10
CPT 98970 Billing & Documentation Guide
CPT code 98970 (Nqhp ol dig assmt&mgmt 5-10) is classified under Medicine/E&M with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.25, a non-facility practice expense RVU of 0.11, and a malpractice RVU of 0.01, a total non-facility RVU of 0.37 and facility RVU of 0.31. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $12.64, though rates vary from $11.68 to $16.62 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 98970, 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 98970 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 98970 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 98970
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.25 | 0.25 |
| Practice Expense RVU | 0.11 | 0.05 |
| Malpractice RVU | 0.01 | 0.01 |
| Total RVU | 0.37 | 0.31 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 98970
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 | $13.18 | $10.81 | $12.7 - $14.75 | 29 |
| Florida | $12.69 | $10.68 | $12.36 - $13.02 | 3 |
| Georgia | $12.27 | $10.36 | $12.03 - $12.51 | 2 |
| Illinois | $12.57 | $10.63 | $12.23 - $12.87 | 4 |
| Michigan | $12.27 | $10.39 | $12.08 - $12.46 | 2 |
| North Carolina | $11.99 | $10.12 | $11.99 - $11.99 | 1 |
| New York | $13.3 | $11.06 | $12.08 - $13.87 | 5 |
| Ohio | $12.04 | $10.21 | $12.04 - $12.04 | 1 |
| Pennsylvania | $12.38 | $10.42 | $12.04 - $12.72 | 2 |
| Texas | $12.32 | $10.35 | $12 - $12.55 | 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 98970
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 98970 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 |
| 96523 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 99424 | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 99425 | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 99426 | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 99427 | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 99437 | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| 99489 | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
| G0250 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 98970
What does CPT code 98970 mean? +
CPT code 98970 represents: Nqhp ol dig assmt&mgmt 5-10. It's in the Medicine/E&M category with a global period of XXX.
What is the Medicare reimbursement for CPT 98970? +
The 2026 Medicare national average non-facility payment for CPT 98970 is $12.64. Rates range from $11.68 to $16.62 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 98970? +
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 98970? +
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