CPT 91299 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Medicine Services and Procedures • Gastroenterology Procedures |
| Common Place of Service | • 11 - Office • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 26 - Professional component • PO - Services, procedures and/or surgeries furnished at off-campus provider-based outpatient departments |
| Complexity Level | Moderate |
National average reimbursement for CPT 91299 by major payers:
$945.73
$39.86
$49.82
$744.19
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 91299 | ||||||
United | 91299 | $1400.00 | 1205189172 - EMERUS BHS SA THOUSAND OAKS, LLC, BAPTIST NEIGHBORHOOD HOSPITAL OVERLOOK | 452497248 - (TX) EMERUS BHS SA THOUSAND OAKS LLC | TX | General Acute Care Hospital (282N00000X) |
United | 91299 | $1741.00 | 1356901235 - UNIVERSITY OF COLORADO HOSPITAL AUTHORITY | 841179794 - (CO) UNIVERSITY OF COLORADO HOSPITAL AUTHORITY | CO | General Acute Care Hospital (282N00000X) |
United | 91299 | $935.00 | 1962425611 - HOLY CROSS HOSPITAL | 362170133 - (IL) HOLY CROSS HOSPITAL | IL | General Acute Care Hospital (282N00000X) |
United | 91299 | $1143.00 | 1205382413 - EMERUS BHS SA THOUSAND OAKS, LLC, BAPTIST NEIGHBORHOOD HOSPITAL ZARZAMORA | 452497248 - (TX) EMERUS BHS SA THOUSAND OAKS LLC | TX | General Acute Care Hospital (282N00000X) |
United | 91299 | $940.91 | 1831103654 - INTEGRIS BAPTIST MEDICAL CENTER INC | 731034824 - (OK) INTEGRIS BAPTIST MEDICAL CENTER INC | OK | General Acute Care Hospital (282N00000X) |
United | 91299 | $1209.00 | 1700998697 - HOLY FAMILY MEMORIAL INC, FROEDTERT HOLY FAMILY MEMORIAL HOSPITAL | 390806395 - HOLY FAMILY MEMORIAL INC | WI | General Acute Care Hospital (282N00000X) |
United | 91299 | $1400.00 | 1417980202 - TEXAS HEALTH HARRIS METHODIST HOSPITAL SOUTHWEST FORT WORTH | 752678857 - (TX) TEXAS HEALTH HARRIS METHODIST HOSPITAL SOUTHWEST FORT WORTH | TX | General Acute Care Hospital (282N00000X) |
United | 91299 | $730.00 | 1467496802 - ST FRANCIS HOSPITAL, INC., ST. FRANCIS EASTSIDE | 582504530 - (SC) ST FRANCIS HOSPITAL INC | SC | General Acute Care Hospital (282N00000X) |
United | 91299 | $809.00 | 1538174347 - LCMC HEALTH HOLDINGS INC, EAST JEFFERSON GENERAL HOSPITAL | 621596506 | LA | General Acute Care Hospital (282N00000X) |
United | 91299 | $1673.00 | 1831185156 - KATHERINE SHAW BETHEA HOSPITAL-DME | 361000540 - (IL) KATHERINE SHAW BETHEA HOSPITAL | IL | General Acute Care Hospital (282N00000X) |
United | 91299 | $2174.00 | 1538110556 - DUPONT HOSPITAL LLC, DUPONT HOSPITAL | 621801445 - (IN) DUPONT HOSPITAL LLC | IN | General Acute Care Hospital (282N00000X) |
United | 91299 | $1793.00 | 1780653618 - H. LEE MOFFITT CANCER CENTER AND RESEARCH INSTITUTE HOSPITAL, INC. | 593238634 - (FL) H LEE MOFFITT CANCER CENTER AND RESEARCH INSTITUTE HOSPITAL INC | FL | Special Hospital (284300000X) |
United | 91299 | $1405.00 | 1427618305 - UNIVERSITY OF COLORADO HOSPITAL AUTHORITY | 841179794 - (CO) UNIVERSITY OF COLORADO HOSPITAL AUTHORITY | CO | General Acute Care Hospital (282N00000X) |
United | 91299 | $3686.00 | 1508315516 - ADVOCATE HEALTH & HOSPITALS CORPORATION | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Children's Hospital (282NC2000X) |
United | 91299 | $117.00 | 1699770149 - MUENSTER HOSPITAL DISTRICT, MUENSTER MEMORIAL HOSPITAL | 751244289 - (TX) MUENSTER HOSPITAL DISTRICT | TX | Critical Access Hospital (282NC0060X) |
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 91299 vs. Other Gastroenterology Procedures Codes
The CPT 91299 code is part of the Medicine Services and Procedures services used for Gastroenterology 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 91299 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 |
|---|---|---|
| 91117-CPT | Low | Colon Motility (Manometric) Study, Minimum 6 Hours Continuous Recording (Including Provocation Tests, Eg, Meal, Intracolonic Balloon Distension, Pharmacologic Agents, If Performed), With Interpretation And Report |
| 91120-CPT | Moderate | Rectal Sensation, Tone, And Compliance Test (Ie, Response To Graded Balloon Distention) |
| 91122-CPT | Moderate | Anorectal Manometry |
| 91299-CPT | Moderate | Unlisted Diagnostic Gastroenterology Procedure |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 91299. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 91299 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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