98004 Medicare Reimbursement Rate (2026)
Current CMS pricing and breakdown for Synch audio-video est sf 10.
National Average Payment
This code is excluded/invalid for Medicare.
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Code Description
Synchronous audio-video evaluation and management service for an established patient requiring straightforward medical decision making; 10 minutes must be met when time determines code selection.
Reimbursement Summary
CPT code 98004 (Synchronous audio-video evaluation and management service for an established patient requiring straightforward medical decision making; 10 minutes must be met when time determines code selection.) does not currently have a published national facility or non-facility reimbursement rate in 2026. The code carries 1.23 total RVUs across work, practice expense, and malpractice components.
98004 is a CPT code in the category “Physician Service.” Medicare does not publish a single national payment amount for this code in 2026 (Not Covered). This code is excluded/invalid for Medicare.
Because this code is not covered/invalid for Medicare, a reimbursement rate is not expected under Medicare rules. If you believe this should be payable, verify directly with CMS or your MAC.
Q4 2026 Breakdown
| Component | Office (Non-Fac) | Facility (Hosp) |
|---|---|---|
| Work RVU | 0.7 | 0.7 |
| Practice Expense (PE) | 0.49 | 0.16 |
| Malpractice (MP) | 0.04 | 0.04 |
| Total RVUs | 1.23 | 0.90 |
Are you being paid correctly for this code?
Compare a payment against the Medicare benchmark for this code.
Medicare rates are used as a benchmark only. Actual payer contracts, modifiers, place of service, units, and billing rules may affect reimbursement. This tool is for educational and operational review purposes, not legal or billing advice.
Facility vs. Non-Facility (Office) Payment
Medicare often publishes two payment rates for the same code: a **non-facility** rate (typically used when the service is performed in a private office where the clinician bears more overhead) and a **facility** rate (typically used when performed in a hospital or facility where the facility bills separately for its costs).
Because the practice expense portion of RVUs differs by setting, the non-facility and facility payment amounts can be different. For locality-adjusted estimates in 2026, use MedFeeSchedule's Medicare Physician Fee Schedule Lookup Tool.
Learn How This Reimbursement Is Calculated
Medicare reimbursement is determined by RVUs, geographic adjustments, and the annual conversion factor.
Frequently Asked Questions
What is the 2026 Medicare rate for 98004?
Medicare does not cover/recognize 98004 as payable under its rules (This code is excluded/invalid for Medicare.). A national reimbursement rate is not expected for 2026.
What is the description for code 98004?
Synchronous audio-video evaluation and management service for an established patient requiring straightforward medical decision making; 10 minutes must be met when time determines code selection.
Why do facility and non-facility payments differ for 98004?
For many physician services, Medicare publishes different practice-expense RVUs by setting. In general, non-facility rates apply when services are performed in a private office, while facility rates apply when performed in a hospital or facility where the facility bills separately.
How can I find my local Medicare rate for 98004?
Use MedFeeSchedule's Medicare Physician Fee Schedule Lookup Tool on the homepage to estimate your locality-adjusted reimbursement. Medicare payment can vary based on geographic adjustments (GPCI), place of service, and claim specifics.
Is 98004 covered by Medicare?
Coverage depends on medical necessity, setting, and Medicare policy. Some codes may be bundled, contractor-priced, or restricted. Verify final coverage guidance through CMS or your local MAC when applicable.
