CPT 95990 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 • Neurology and Neuromuscular Procedures |
| Common Place of Service | • None • 99 - Other POS • 11 - Office |
| Common Modifiers | • None • GY - Notice of Liability Not Issued, Not Required Under Payer Policy. • PO - Services, procedures and/or surgeries furnished at off-campus provider-based outpatient departments |
| Complexity Level | Low |
National average reimbursement for CPT 95990 by major payers:
$117.72
$105.99
$106.70
$140.25
| 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 95990 | ||||||
United | 95990 | $582.00 | 1851496152 - SSM HEALTH CARE ST. LOUIS, SSM HEALTH ST. CLARE HOSPITAL - FENTON | 431343281 - SSM HEALTH CARE ST LOUIS | MO | General Acute Care Hospital (282N00000X) |
United | 95990 | $97.20 | 1457345910 - BRADLEY SMITH | 561079264 - EMERGEORTHO, P.A. | NC | Orthopaedic Surgery Physician (207X00000X) |
United | 95990 | $293.00 | 1851487086 - FAIRWAY MEDICAL CENTER, LLC, AVALA | 721426390 - (LA) FAIRWAY MEDICAL CENTER LLC | LA | General Acute Care Hospital (282N00000X) |
United | 95990 | $2145.00 | 1336109107 - SENTARA HOSPITALS, SENTARA CAREPLEX HOSPITAL | 541547408 - SENTARA HOSPITALS | VA | General Acute Care Hospital (282N00000X) |
United | 95990 | $706.00 | 1962464016 - BON SECOURS ST. MARY'S HOSPITAL OF RICHMOND LLC, BON SECOURS ST MARY'S HOSPITAL | 540793767 - BON SECOURS ST MARYS HOSPITAL OF RICHMOND LLC | VA | General Acute Care Hospital (282N00000X) |
United | 95990 | $464.00 | 1821215013 - ANDERSON REGIONAL MEDICAL CENTER, PROF FEES-CRNA | 640362400 - (MS) ANDERSON REGIONAL MEDICAL CENTER | MS | General Acute Care Hospital (282N00000X) |
United | 95990 | $52.43 | 1124006721 - ULTRASOUND DIAGNOSTIC SERVICES, DIAGNOSTIC HEALTH SERVICES | 860291562 | AZ | Radiology Clinic/Center (261QR0200X) |
United | 95990 | $210.00 | 1972581940 - THE COMMUNITY HOSPITAL OF BRAZOSPORT, BRAZOSPORT MEMORIAL HOSPITAL &BRAZOSPORT REGIONAL HEALTH SYSTEM | 741385192 - (TX) COMMUNITY HOSPITAL OF BRAZOSPORT | TX | General Acute Care Hospital (282N00000X) |
United | 95990 | $6291.00 | 1912014564 - ADVOCATE NORTH SIDE HEALTH NETWORK, ADVOCATE ILLINOIS MASONIC MEDICAL CENTER | 363196629 - (IL) ADVOCATE NORTH SIDE HEALTH NETWORK | IL | General Acute Care Hospital (282N00000X) |
United | 95990 | $2866.00 | 1346729159 - BAYLOR SCOTT & WHITE MEDICAL CENTERS, BAYLOR SCOTT & WHITE MEDICAL CENTER - PFLUGERVILLE | 813040663 - (TX) BAYLOR SCOTT & WHITE MEDICAL CENTERS-CAPITOL AREA | TX | General Acute Care Hospital (282N00000X) |
United | 95990 | $57.00 | 1811215510 - RANKIN COUNTY HOSPITAL DISTRICT | 751248028 - (TX) RANKIN COUNTY HOSPITAL DISTRICT | TX | Critical Access Hospital (282NC0060X) |
United | 95990 | $175.16 | 1487626370 - MARY HARRIS | 521958352 - ATLANTIC HEALTH SYSTEM INC | NJ | Internal Medicine Physician (207R00000X) |
United | 95990 | $947.00 | 1225083785 - CAMBRIDGE PUBLIC HEALTH COMMISSION | 43320571 | MA | General Acute Care Hospital (282N00000X) |
United | 95990 | $7250.00 | 1811992480 - PASCACK VALLEY HOSPITAL | 264051248 | NJ | General Acute Care Hospital (282N00000X) |
United | 95990 | $818.35 | 1831233642 - WESTMORELAND REGIONAL HOSPITAL | 250965612 - EXCELA HEALTH | 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 95990 vs. Other Neurology and Neuromuscular Procedures Codes
The CPT 95990 code is part of the Medicine Services and Procedures services used for Neurology and Neuromuscular 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 95990 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 |
|---|---|---|
| 95983-CPT | Low | Electronic Analysis Of Implanted Neurostimulator Pulse Generator/Transmitter (Eg, Contact Group[S], Interleaving, Amplitude, Pulse Width, Frequency [Hz], On/Off Cycling, Burst, Magnet Mode, Dose Lockout, Patient Selectable Parameters, Responsive Neurostimulation, Detection Algorithms, Closed Loop Parameters, And Passive Parameters) By Physician Or Other Qualified Health Care Professional; With Brain Neurostimulator Pulse Generator/Transmitter Programming, First 15 Minutes Face-To-Face Time With |
| 95984-CPT | Low | Electronic Analysis Of Implanted Neurostimulator Pulse Generator/Transmitter (Eg, Contact Group[S], Interleaving, Amplitude, Pulse Width, Frequency [Hz], On/Off Cycling, Burst, Magnet Mode, Dose Lockout, Patient Selectable Parameters, Responsive Neurostimulation, Detection Algorithms, Closed Loop Parameters, And Passive Parameters) By Physician Or Other Qualified Health Care Professional; With Brain Neurostimulator Pulse Generator/Transmitter Programming, Each Additional 15 Minutes Face-To-Face |
| 95990-CPT | Low | Refilling And Maintenance Of Implantable Pump Or Reservoir For Drug Delivery, Spinal (Intrathecal, Epidural) Or Brain (Intraventricular), Includes Electronic Analysis Of Pump, When Performed; |
| 95991-CPT | Low | Refilling And Maintenance Of Implantable Pump Or Reservoir For Drug Delivery Spinal (Intrathecal Epidural) Or Brain (Intraventricular) Includes Electronic Analysis Of Pump When Performed; Requiring Skill Of A Physician Or Other Qualified Health Care Professional (Revised 01/01/13) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 95990. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 95990 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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