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 | $97.20 | 1457345910 - BRADLEY SMITH | 561079264 - EMERGEORTHO, P.A. | NC | Orthopaedic Surgery Physician (207X00000X) |
United | 95990 | $64.19 | 1225014657 - CAROLINA RADIOLOGY ASSOCIATES LLC | 571049603 - (SC) CAROLINA RADIOLOGY ASSOCIATES, LLC | SC | Diagnostic Radiology Physician (2085R0202X) |
United | 95990 | $97.20 | 1457345910 - BRADLEY SMITH | 561079264 - EMERGEORTHO, P.A. | NC | Orthopaedic Surgery Physician (207X00000X) |
United | 95990 | $878.00 | 1083644579 - BRONSON BATTLE CREEK HOSPITAL | 382776791 - (MI) BRONSON BATTLE CREEK HOSPITAL | MI | General Acute Care Hospital (282N00000X) |
United | 95990 | $245.00 | 1699714303 - MACON COUNTY SAMARITAN HOSPITAL, SAMARITAN HOSPITAL | 436003377 | MO | Critical Access Hospital (282NC0060X) |
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 | $1123.31 | 1306992151 - SWEDISH HEALTH SERVICES, SWEDISH MEDICAL CENTER | 910433740 - (WA) SWEDISH HEALTH SERVICES | WA | General Acute Care Hospital (282N00000X) |
United | 95990 | $692.00 | 1407859655 - DELNOR COMMUNITY HOSPITAL, NORTHWESTERN MEDICINE DELNOR COMMUNITY HOSPITAL | 363484281 - (IL) DELNOR COMMUNITY HOSPITAL | IL | General Acute Care Hospital (282N00000X) |
United | 95990 | $551.00 | 1538667035 - CARTHAGE HOSPITAL, LLC | 824005981 | TX | General Acute Care Hospital (282N00000X) |
United | 95990 | $222.60 | 1285669036 - ROBERT RUBINO | 521958352 - ATLANTIC HEALTH SYSTEM INC | NJ | Obstetrics & Gynecology Physician (207V00000X) |
United | 95990 | $180.41 | 1215909320 - REBECCA GRIFFITH | 521958352 - ATLANTIC HEALTH SYSTEM INC | NJ | Internal Medicine Physician (207R00000X) |
United | 95990 | $180.41 | 1487626370 - MARY HARRIS | 521958352 - ATLANTIC HEALTH SYSTEM INC | NJ | Internal Medicine Physician (207R00000X) |
United | 95990 | $175.16 | 1487626370 - MARY HARRIS | 521958352 - ATLANTIC HEALTH SYSTEM INC | NJ | Internal Medicine Physician (207R00000X) |
United | 95990 | $180.41 | 1417106907 - OVERLOOK HOSPITAL | 521958352 - ATLANTIC HEALTH SYSTEM INC | NJ | General Acute Care Hospital (282N00000X) |
United | 95990 | $3775.00 | 1568442309 - THE COOPER HEALTH SYSTEM | 210634462 - (NJ) COOPER HEALTH SYSTEM A NEW JERSEY NON-PROFIT CORPORATION | NJ | 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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