98005 Medicare Reimbursement Rate (2026)
Current CMS pricing and breakdown for Synch audio-video est low 20.
National Average Payment
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Historical Medicare Reimbursement
| Quarter | Non-Facility Rate | Facility Rate | YoY % Change (Non-Fac) | YoY % Change (Fac) |
|---|---|---|---|---|
| 2026 Q3 | $71.48 | $55.45 | +6.24% | -8.81% |
| 2026 Q2 | $71.48 | $55.45 | +6.24% | -8.81% |
| 2026 Q1 | $71.48 | $55.45 | +6.24% | -8.81% |
| 2025 Q4 | $67.28 | $60.81 | — | — |
| 2025 Q3 | $67.28 | $60.81 | — | — |
| 2025 Q2 | $67.28 | $60.81 | — | — |
| 2025 Q1 | $67.28 | $60.81 | — | — |
Code Description
A synchronous audio-video telehealth visit for an established patient requiring low complexity medical decision making or approximately 20 minutes of total time. An E/M service delivered via real-time audio and video technology connecting the patient and provider at different locations.
Reimbursement Summary
CPT code 98005 (A synchronous audio-video telehealth visit for an established patient requiring low complexity medical decision making or approximately 20 minutes of total time. An E/M service delivered via real-time audio and video technology connecting the patient and provider at different locations.) had a 2026 Medicare non-facility reimbursement rate of $71.48. This reflects a 6.24% change from the prior year. The code carries 2.14 total RVUs across work, practice expense, and malpractice components.
For 2026, the estimated National Average Medicare payment for 98005 is $71.48 in a non-facility (office) setting and $55.45 in a facility (hospital/outpatient) setting. Your actual reimbursement depends on locality adjustments.
This code’s RVU components (Work, Practice Expense, and Malpractice) combine to approximately 2.14 total RVUs in the office setting and 1.66 total RVUs in the facility setting.
Description: A synchronous audio-video telehealth visit for an established patient requiring low complexity medical decision making or approximately 20 minutes of total time.... For locality-adjusted estimates, use MedFeeSchedule's Medicare Physician Fee Schedule Lookup Tool.
Q3 2026 Breakdown
| Component | Office (Non-Fac) | Facility (Hosp) |
|---|---|---|
| Work RVU | 1.3 | 1.3 |
| Practice Expense (PE) | 0.77 | 0.29 |
| Malpractice (MP) | 0.07 | 0.07 |
| Total RVUs | 2.14 | 1.66 |
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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 98005?
Medicare does not publish a single national reimbursement rate for 98005 in 2026 (No National Rate). Use MedFeeSchedule's Medicare Physician Fee Schedule Lookup Tool to explore locality-adjusted estimates when applicable.
What is the description for code 98005?
A synchronous audio-video telehealth visit for an established patient requiring low complexity medical decision making or approximately 20 minutes of total time. An E/M service delivered via real-time audio and video technology connecting the patient and provider at different locations.
Why do facility and non-facility payments differ for 98005?
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 98005?
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 98005 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.
