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 | $4595.00 | 1023587045 - KETTERING MEDICAL CENTER, KETTERING HEALTH TROY | 310621866 - (OH) KETTERING COLLEGE | OH | 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 | $1095.00 | 1538535158 - SMSJ TUCSON HOLDINGS LLC, ST. JOSEPHS HOSPITAL | 474131755 | AZ | 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 | $2256.00 | 1477807436 - UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL CENTER AT DALLAS | 753175630 | TX | General Acute Care Hospital (282N00000X) |
United | 91299 | $196.00 | 1699754812 - HARDIN COUNTY GENERAL HOSPITAL, HARDIN MEDICAL CENTER | 626002428 - (TN) HARDIN COUNTY GENERAL HOSPITAL | TN | 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 | $252.00 | 1417941295 - UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT TYLER | 756001354 | TX | General Acute Care Hospital (282N00000X) |
United | 91299 | $693.00 | 1164463493 - SAINT FRANCIS MEDICAL CENTER, OUTPATIENT SERVICES | 370662569 - (IL) SAINT FRANCIS MEDICAL CENTER | IL | General Acute Care Hospital (282N00000X) |
United | 91299 | $633.00 | 1386651297 - PORTERCARE ADVENTIST HEALTH SYSTEM, ADVENTHEALTH PARKER | 840438224 - PORTERCARE ADVENTIST HEALTH SYSTEM | CO | General Acute Care Hospital (282N00000X) |
United | 91299 | $704.00 | 1477591055 - THE MOSES H. CONE MEMORIAL HOSPITAL OPERATING CORPORATION | 581588823 - THE MOSES H CONE MEMORIAL HOSPITAL OPERATING CORPORATION | NC | General Acute Care Hospital (282N00000X) |
United | 91299 | $1925.00 | 1497702575 - ORANGE COAST MEMORIAL MEDICAL CENTER | 330687414 - (CA) MEMORIAL HEALTH SERVICES | CA | General Acute Care Hospital (282N00000X) |
United | 91299 | $479.00 | 1356860621 - CHI MEMORIAL HOSPITAL | 822748395 - CHI MEMORIAL HOSPITAL - GEORGIA | GA | General Acute Care Hospital (282N00000X) |
United | 91299 | $1623.00 | 1982442398 - SAINT FRANCIS HOSPITAL | 992441755 | 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 | 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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