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 |
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 | $35.00 | 1588756076 - ALL WAYS HOMECARE INC | 202696236 | FL | Home Health Agency (251E00000X) |
United | 95199 | $49.45 | 1467608869 - CALHOUN HEALTH SERVICES | 813257997 - (MS) BAPTIST MEMORIAL HOSPITAL - CALHOUN INC | MS | Critical Access Hospital (282NC0060X) |
United | 95199 | $111.80 | 1508312604 - PRISMA HEALTH-UPSTATE, PRISMA HEALTH OP SURGERY CROSS CREEK | 811723202 - PRISMA HEALTH - UPSTATE | SC | General Acute Care Hospital (282N00000X) |
United | 95199 | $103.01 | 1548380900 - HUNTERDON MEDICAL CENTER | 221537688 - HUNTERDON MEDICAL CENTER | NJ | General Acute Care Hospital (282N00000X) |
United | 95199 | $51.63 | 1033229240 - SURGICAL HOSPITAL OF OKLAHOMA LLC | 731521890 - (OK) SURGICAL HOSPITAL OF OKLAHOMA LLC | OK | General Acute Care Hospital (282N00000X) |
United | 95199 | $86.40 | 1326002049 - UNIVERSITY OF WASHINGTON, UNIVERSITY OF WASHINGTON MEDICAL CENTER | 916001537 | WA | General Acute Care Hospital (282N00000X) |
United | 95199 | $111.80 | 1902352008 - PRISMA HEALTH-UPSTATE, PRISMA HEALTH CANCER INST-SPARTANBURG | 811723202 - PRISMA HEALTH - UPSTATE | SC | General Acute Care Hospital (282N00000X) |
United | 95199 | $74.44 | 1588269898 - WEST PENN ALLEGHENY HEALTH SYSTEM, INC, AHN WEXFORD HOSPITAL | 250969492 - (PA) HIGHMARK HEALTH | PA | General Acute Care Hospital (282N00000X) |
United | 95199 | $42.58 | 1275217606 - NORTHWEST MISS REGIONAL MEDICAL CENTER, NORTHWEST MISSISSIPPI REGIONAL MEDICAL CENTER | 646001574 | MS | General Acute Care Hospital (282N00000X) |
United | 95199 | $96.15 | 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 | $29.25 | 1659392595 - SURGERY CENTER AT EDGEWOOD PLACE, LLC, EDGEWOOD SURGICAL HOSPITAL | 481256749 - SURGERY CENTER AT EDGEWOOD PLACE, LLC DBA EDGEWOOD SURGICAL HOSPITAL | PA | General Acute Care Hospital (282N00000X) |
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 | $45.65 | 1306876065 - ST DOMINIC-JACKSON MEMORIAL HOSPITAL | 640303091 - (MS) ST DOMINICJACKSON MEMORIAL HOSPITAL | MS | General Acute Care Hospital (282N00000X) |
United | 95199 | $32.59 | 1225450588 - PARISH HOSPITAL SERVICE DISTRICT FOR THE PARISH OF ORLEANS, NEW ORLEANS EAST HOSPITAL | 273335876 | LA | General Acute Care Hospital (282N00000X) |
United | 95199 | $96.41 | 1366492977 - LUCY WEBB HAYES NATIONAL TRAINING SCHOOL FOR DEACONESSES & MISSIONARIE, SIBLEY MEMORIAL HOSPITAL | 530196602 - (DC) LUCY WEBB HAYNES NATIONAL TRAINING SCHOOL FOR DEACONESSES AND MISSION | DC | 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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