CPT 95199 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 • Allergy and Clinical Immunology Procedures |
| Common Place of Service | • 11 - Office • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 59 - Distinct Procedural Service • GA - Required ABN issued and on file |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 95199 |
National average reimbursement for CPT 95199 by major payers:
$670.74
$174.66
$67.77
$268.89
| 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 95199 | ||||||
United | 95199 | $76.08 | 1417990805 - NORTHFIELD HOSPITAL, NORTHFIELD HOSPITAL | 416007241 | MN | Rural Acute Care Hospital (282NR1301X) |
United | 95199 | $69.22 | 1417900713 - QHG OF SPRINGDALE INC, NORTHWEST MEDICAL CENTER -- BENTONVILLE | 205896848 | AR | General Acute Care Hospital (282N00000X) |
United | 95199 | $33.18 | 1609603877 - LIFESPAN OF MASSACHUSETTS | 994836263 | MA | General Acute Care Hospital (282N00000X) |
United | 95199 | $51.63 | 1942392600 - THE FINLEY HOSPITAL, UNITYPOINT HEALTH - FINLEY HOSPTIAL | 420680354 - THE FINLEY HOSPITAL | IA | General Acute Care Hospital (282N00000X) |
United | 95199 | $60.43 | 1225272552 - MAPLE GROVE HOSPITAL CORPORATION | 208316475 - MAPLE GROVE HOSPITAL CORPORATION | MN | General Acute Care Hospital (282N00000X) |
United | 95199 | $64.27 | 1962512871 - PONTOTOC HEALTH SERVICES, INC., PONTOTOC HEALTH SERVICES CAH - SWING BED | 640751410 - (MS) PONTOTOC HEALTH SERVICES INC | MS | Critical Access Hospital (282NC0060X) |
United | 95199 | $60.43 | 1144255159 - FRICK HOSPITAL | 250965375 - (PA) FRICK HOSPITAL | PA | General Acute Care Hospital (282N00000X) |
United | 95199 | $101.47 | 1073711065 - MEDSTAR GEORGETOWN MEDICAL CENTER, INC, GEORGETOWN UNIVERSITY HOSPITAL PHYSICIANS | 522218584 - (DC) MEDSTAR-GEORGETOWN MEDICAL CENTER INC | DC | General Acute Care Hospital (282N00000X) |
United | 95199 | $28.02 | 1932211851 - SOUTHWEST MISSISSIPPI REGIONAL MEDICAL CENTER, LAWRENCE COUNTY HOSPITAL | 640468873 | MS | Critical Access Hospital (282NC0060X) |
United | 95199 | $72.05 | 1376596569 - WOMENS CENTER OF NORTHWEST ARKANSAS LLC, WILLOW CREEK WOMEN'S HOSPITAL | 205896848 | AR | General Acute Care Hospital (282N00000X) |
United | 95199 | $30.48 | 1356345318 - NEBRASKA ORTHOPAEDIC HOSPITAL LLC | 470845237 - (NE) NEBRASKA ORTHOPAEDIC HOSPITAL LLC | NE | General Acute Care Hospital (282N00000X) |
United | 95199 | $47.77 | 1043455199 - SISTERS OF CHARITY HOSPITAL, ST. JOSEPH CAMPUS | 160743187 - (NY) SISTERS OF CHARITY HOSPITAL OF BUFFALO NEW YORK | NY | General Acute Care Hospital (282N00000X) |
United | 95199 | $40.93 | 1689653305 - WILLIAM BEAUMONT HOSPITAL, COREWELL HEALTH WILLIAM BEAUMONT UNIVERSITY HOSPITAL | 381459362 - WILLIAM BEAUMONT HOSPITAL | MI | General Acute Care Hospital (282N00000X) |
United | 95199 | $49.45 | 1003062407 - CALHOUN HEALTH SERVICES | 813257997 - (MS) BAPTIST MEMORIAL HOSPITAL - CALHOUN INC | MS | Critical Access Hospital (282NC0060X) |
United | 95199 | $50.81 | 1265664544 - PHYSICIANS CARE SURGICAL HOSPITAL LP | 261239962 - (PA) PHYSICIANS CARE SURGICAL HOSPITAL LP | PA | 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 95199 vs. Other Allergy and Clinical Immunology Procedures Codes
The CPT 95199 code is part of the Medicine Services and Procedures services used for Allergy and Clinical Immunology 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 95199 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 |
|---|---|---|
| 95144-CPT | Low | Professional Services For The Supervision Of Preparation And Provision Of Antigens For Allergen Immunotherapy; Single Dose Vial(S) (Specify Number Of Vials) |
| 95145-CPT | Low | Professional Services For The Supervision Of Preparation And Provision Of Antigens For Allergen Immunotherapy (Specify Number Of Doses); Single Stinging Insect Venom |
| 95146-CPT | Low | Professional Services For The Supervision Of Preparation And Provision Of Antigens For Allergen Immunotherapy (Specify Number Of Doses); Two Single Stinging Insect Venoms |
| 95199-CPT | Moderate | Unlisted Allergy/Clinical Immunologic Service Or Procedure |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 95199. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 95199 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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