CPT 81099 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | Urinalysis Procedures Pathology and Laboratory Procedures |
| Common Place of Service | 99 - Other POS 11 - Office 50 - Federally Qualified Health Center |
| Common Modifiers | None 59 - Distinct Procedural Service QW - CLIA Waived Tests |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 81099 |
National average reimbursement for CPT 81099 by major payers:
$1,280.86
$9.38
$6.55
$93.28
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 81099 | $68.00 | 1952400657 - KIMBERLY YARNALL | 223102230 - (PA) MOUNTAIN VALLEY ORTHOPEDICS, P.C. | PA | Chiropractor (111N00000X) |
United | 81099 | $60.00 | 1649599168 - RESTORATIVE HEALTH REHABILITATION INC | 272533824 - (FL) RESTORATIVE HEALTH REHABILITATION INC | FL | Home Health Agency (251E00000X) |
United | 81099 | $40.00 | 1649599168 - RESTORATIVE HEALTH REHABILITATION INC | 272533824 - (FL) RESTORATIVE HEALTH REHABILITATION INC | FL | Home Health Agency (251E00000X) |
United | 81099 | $35.00 | 1649599168 - RESTORATIVE HEALTH REHABILITATION INC | 272533824 - (FL) RESTORATIVE HEALTH REHABILITATION INC | FL | Home Health Agency (251E00000X) |
United | 81099 | $40.00 | 1649599168 - RESTORATIVE HEALTH REHABILITATION INC | 272533824 - (FL) RESTORATIVE HEALTH REHABILITATION INC | FL | Home Health Agency (251E00000X) |
United | 81099 | $2.13 | 1700854288 - LAMB HEALTHCARE CENTER | 752388515 - (TX) LAMB HEALTHCARE CENTER | TX | General Acute Care Hospital (282N00000X) |
United | 81099 | $55.00 | 1952400657 - KIMBERLY YARNALL | 223102230 - (PA) MOUNTAIN VALLEY ORTHOPEDICS, P.C. | PA | Chiropractor (111N00000X) |
United | 81099 | $40.00 | 1588756076 - ALL WAYS HOMECARE INC | 202696236 | FL | Home Health Agency (251E00000X) |
United | 81099 | $55.00 | 1801164967 - DA PEDIATRIC REHABILITATION | 270939565 - (FL) DA PEDIATRIC REHABILITATION | FL | Home Health Agency (251E00000X) |
United | 81099 | $35.00 | 1588756076 - ALL WAYS HOMECARE INC | 202696236 | FL | Home Health Agency (251E00000X) |
United | 81099 | $2.13 | 1447259627 - TYLER COUNTY HOSPITAL DISTRICT | 746067306 | TX | General Acute Care Hospital (282N00000X) |
United | 81099 | $6.07 | 1972517365 - COVENANT MEDICAL CENTER | 822913146 - (TX) COVENANT MEDICAL CENTER | TX | General Acute Care Hospital (282N00000X) |
United | 81099 | $19.44 | 1811735384 - THE MEDICAL CENTER OF CENTRAL GEORGIA INC. | 582149128 - MEDICAL CENTER OF CENTRAL GEORGIA INC | GA | Children's Hospital (282NC2000X) |
United | 81099 | $35.00 | 1649599168 - RESTORATIVE HEALTH REHABILITATION INC | 272533824 - (FL) RESTORATIVE HEALTH REHABILITATION INC | FL | Home Health Agency (251E00000X) |
United | 81099 | $40.00 | 1801164967 - DA PEDIATRIC REHABILITATION | 270939565 - (FL) DA PEDIATRIC REHABILITATION | FL | Home Health Agency (251E00000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 81099 vs. Other Pathology and Laboratory Procedures Codes
The CPT 81099 code is part of the Urinalysis Procedures services used for Pathology and Laboratory Procedures. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 81099 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 80434-CPT | Low | Acth Insufficiency Test, This Test Uses A Pretest Blood Sample As A Baseline To Compare A Fasting Blood Sample After Taking Insulin. The Test Measures Acth To Evaluate Interaction Between The Hypothalamus And Pituitary Gland In The Brain And The Adrenal Glands. |
| 81001-CPT | Low | Urine Analysis, Urine Test That Checks Ph And Looks For Substances Such As Blood Crystals Bile And White Blood Cells (Antibodies). These May Be Viewed Under A Microscope Or Detected With Dip Sticks Or Colorizing Tablets. A Computer Analysis May Be Done As Well. |
| 81005-CPT | Low | Urine Analysis For A Substance, Basic Urine Analysis For A Particular Substance Such As Blood Antibodies Bile Or Crystals. The Result May Be Recorded Simply As Positive Or Negative. |
| 81099-CPT | High | Urine Analysis, Urine Test That Checks Ph And Looks For Substances Such As Blood Crystals Bile And White Blood Cells (Antibodies). These May Be Viewed Under A Microscope Or Detected With Dip Sticks Or Colorizing Tablets. A Computer Analysis May Be Done As Well. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 81099. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 81099 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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