CPT 98971
Global XXX ActiveNqhp ol dig assmt&mgmt 11-20
CPT 98971 Billing & Documentation Guide
CPT code 98971 (Nqhp ol dig assmt&mgmt 11-20) is classified under Medicine/E&M with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.44, a non-facility practice expense RVU of 0.23, and a malpractice RVU of 0.02, a total non-facility RVU of 0.69 and facility RVU of 0.57. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $23.59, though rates vary from $21.64 to $30.59 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 98971, 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 98971 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 98971 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 98971
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.44 | 0.44 |
| Practice Expense RVU | 0.23 | 0.11 |
| Malpractice RVU | 0.02 | 0.02 |
| Total RVU | 0.69 | 0.57 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 98971
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 | $24.67 | $19.93 | $23.72 - $27.75 | 29 |
| Florida | $23.7 | $19.68 | $23.04 - $24.38 | 3 |
| Georgia | $22.85 | $19.03 | $22.35 - $23.35 | 2 |
| Illinois | $23.45 | $19.57 | $22.75 - $24.05 | 4 |
| Michigan | $22.85 | $19.09 | $22.46 - $23.24 | 2 |
| North Carolina | $22.29 | $18.55 | $22.29 - $22.29 | 1 |
| New York | $24.87 | $20.4 | $22.46 - $26.01 | 5 |
| Ohio | $22.38 | $18.72 | $22.38 - $22.38 | 1 |
| Pennsylvania | $23.07 | $19.14 | $22.38 - $23.76 | 2 |
| Texas | $22.96 | $19.02 | $22.31 - $23.45 | 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 98971
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 98971 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 98971
What does CPT code 98971 mean? +
CPT code 98971 represents: Nqhp ol dig assmt&mgmt 11-20. It's in the Medicine/E&M category with a global period of XXX.
What is the Medicare reimbursement for CPT 98971? +
The 2026 Medicare national average non-facility payment for CPT 98971 is $23.59. Rates range from $21.64 to $30.59 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 98971? +
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 98971? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on April 17, 2026.
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