CMS October 2026Physician Fee Schedule · Free lookup

CPT 99152 Medicare Fee Schedule 2026

Medicare's 2026 national payment for CPT 99152 is $51.44 in a non-facility setting ($11.02 in a facility), up 6.0% from $48.52 in 2025.

National rate, October 2026

Non-facility: $51.44
Facility: $11.02
vs. 2025: +6.0%
Commercial national avg.: $58.97

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HCPCS Codes

99152

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Year

20262025

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Physician Fee Schedule·99152·National·2026, 2025

Current non-facility rate

$51.44▲0.0%

Facility: $11.02

Recent trend

Code description

Moderate Sedation Services Provided By The Same Physician Or Other Qualified Health Care Professional Performing The Diagnostic Or Therapeutic Service That The Sedation Supports Requiring The Presence Of An Independent Trained Observer To Assist In The Monitoring Of The Patients Level Of Consciousness And Physiologicalstatus; Initial 15 Minutes Of Intraservice Time Patient Age 5 Years Or Older. (Reinstated 01/01/2017).

Code	Date	State	Non-Facility Fee	Facility Fee	Description
99152	10/2026	N/A	$51.44	$11.02	Moderate Sedation Services Provided By The Same Physician Or Other Qualified Health Care Professional Performing The Diagnostic Or Therapeutic Service That The Sedation Supports Requiring The Presence Of An Independent Trained Observer To Assist In The Monitoring Of The Patients Level Of Consciousness And Physiologicalstatus; Initial 15 Minutes Of Intraservice Time Patient Age 5 Years Or Older. (Reinstated 01/01/2017).
99152	7/2026	N/A	$51.44	$11.02	Moderate Sedation Services Provided By The Same Physician Or Other Qualified Health Care Professional Performing The Diagnostic Or Therapeutic Service That The Sedation Supports Requiring The Presence Of An Independent Trained Observer To Assist In The Monitoring Of The Patients Level Of Consciousness And Physiologicalstatus; Initial 15 Minutes Of Intraservice Time Patient Age 5 Years Or Older. (Reinstated 01/01/2017).
99152	4/2026	N/A	$51.44	$11.02	Moderate Sedation Services Provided By The Same Physician Or Other Qualified Health Care Professional Performing The Diagnostic Or Therapeutic Service That The Sedation Supports Requiring The Presence Of An Independent Trained Observer To Assist In The Monitoring Of The Patients Level Of Consciousness And Physiologicalstatus; Initial 15 Minutes Of Intraservice Time Patient Age 5 Years Or Older. (Reinstated 01/01/2017).
99152	1/2026	N/A	$51.44	$11.02	Moderate Sedation Services Provided By The Same Physician Or Other Qualified Health Care Professional Performing The Diagnostic Or Therapeutic Service That The Sedation Supports Requiring The Presence Of An Independent Trained Observer To Assist In The Monitoring Of The Patients Level Of Consciousness And Physiologicalstatus; Initial 15 Minutes Of Intraservice Time Patient Age 5 Years Or Older. (Reinstated 01/01/2017).
99152	10/2025	N/A	$48.52	$11.65	Moderate Sedation Services Provided By The Same Physician Or Other Qualified Health Care Professional Performing The Diagnostic Or Therapeutic Service That The Sedation Supports Requiring The Presence Of An Independent Trained Observer To Assist In The Monitoring Of The Patients Level Of Consciousness And Physiologicalstatus; Initial 15 Minutes Of Intraservice Time Patient Age 5 Years Or Older. (Reinstated 01/01/2017).
99152	7/2025	N/A	$48.52	$11.65	Moderate Sedation Services Provided By The Same Physician Or Other Qualified Health Care Professional Performing The Diagnostic Or Therapeutic Service That The Sedation Supports Requiring The Presence Of An Independent Trained Observer To Assist In The Monitoring Of The Patients Level Of Consciousness And Physiologicalstatus; Initial 15 Minutes Of Intraservice Time Patient Age 5 Years Or Older. (Reinstated 01/01/2017).
99152	4/2025	N/A	$48.52	$11.65	Moderate Sedation Services Provided By The Same Physician Or Other Qualified Health Care Professional Performing The Diagnostic Or Therapeutic Service That The Sedation Supports Requiring The Presence Of An Independent Trained Observer To Assist In The Monitoring Of The Patients Level Of Consciousness And Physiologicalstatus; Initial 15 Minutes Of Intraservice Time Patient Age 5 Years Or Older. (Reinstated 01/01/2017).
99152	1/2025	N/A	$48.52	$11.65	Moderate Sedation Services Provided By The Same Physician Or Other Qualified Health Care Professional Performing The Diagnostic Or Therapeutic Service That The Sedation Supports Requiring The Presence Of An Independent Trained Observer To Assist In The Monitoring Of The Patients Level Of Consciousness And Physiologicalstatus; Initial 15 Minutes Of Intraservice Time Patient Age 5 Years Or Older. (Reinstated 01/01/2017).

99152 national rate by year

Each row is the latest CMS file published that year. Change is against the year before.

CMS file	Non-facility	Facility	Change
October 2026	$51.44	$11.02	+6.0%
October 2025	$48.52	$11.65	-3.5%
March 2024	$50.26	$11.98	-1.1%
January 2023	$50.83	$12.54	-2.7%
July 2022	$52.26	$12.80	-

This is the national amount before geographic adjustment. Medicare multiplies each relative value unit by its locality's geographic practice cost index, so a practice's own allowed amount can be higher or lower; pick a state above to see its localities. The facility amount applies when the service is performed in a hospital or other facility setting.

99152: Medicare vs. commercial national average

The commercial national average for 99152, the mean of what BCBS, UnitedHealthcare, Aetna and Cigna publish nationwide, is $58.97, 115% of Medicare's $51.44.

BCBS $64.55
UnitedHealthcare $65.37
Aetna $71.05
Cigna $34.89

A national average, not a local rate: each payer's figure averages the unmodified, in-network professional rates it publishes for 99152 across the country in its transparency files. Contracted rates vary widely by market, provider and plan. Medicare's figure is its national non-facility amount before geographic adjustment.

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Medicaid comparison

See what state Medicaid programs pay for 99152

50 state Medicaid agencies publish their own physician fee schedule. The 99152 page shows real published rates for several of them free, with effective dates and official sources.

17,674 codes and 974,327 published rates, taken from the files the state agencies publish themselves.

See Medicaid rates for 99152

$62.13

99153Mod Sed Same Phys Qhp Ea, Moderate Sedation Services Provided By The Same Physician Or Other Qualified Health Care Professional Performing The Diagnostic Or Therapeutic Service That The Sedation Supports Requiring The Presence Of An Independent Trained Observer To Assist In The Monitoring Of The Patient S Level Of Consciousness And Physiological Status Each Additional 15 Minutes Intraservice Time List Separately In Addition To Code For Primary Service

$12.36

99155Mod Sed Oth Phys Qhp 5 Yrs, Moderate Sedation Services Provided By A Physician Or Other Qualified Health Care Professional Other Than The Physician Or Other Qualified Health Care Professional Performing The Diagnostic Or Therapeutic Service That The Sedation Supports Initial 15 Minutes Of Intraservice Time Patient Younger Than 5 Years Of Age

$81.50

Methodology

Rates are sourced directly from CMS Physician Fee Schedule files, indexed quarterly. Non-facility and facility prices are calculated using the published GPCI for each locality and the year's conversion factor.

View CMS Physician Fee Schedule