CPT 95991 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 | • 11 - Office • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 59 - Distinct Procedural Service • PO - Services, procedures and/or surgeries furnished at off-campus provider-based outpatient departments |
| Complexity Level | Low |
National average reimbursement for CPT 95991 by major payers:
$136.46
$138.55
$141.26
$177.02
| 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 95991 | ||||||
United | 95991 | $1496.00 | 1427618305 - UNIVERSITY OF COLORADO HOSPITAL AUTHORITY | 841179794 - (CO) UNIVERSITY OF COLORADO HOSPITAL AUTHORITY | CO | General Acute Care Hospital (282N00000X) |
United | 95991 | $181.00 | 1821477456 - JOHNSTON MEMORIAL HOSPITAL, INC, CENTER FOR SLEEP DISORDERS AT JMH | 540544705 - JOHNSTON MEMORIAL HOSPITAL INC | VA | General Acute Care Hospital (282N00000X) |
United | 95991 | $3691.00 | 1083612881 - ENGLEWOOD HOSPITAL AND MEDICAL CENTER | 221487173 - (NJ) ENGLEWOOD HOSPITAL AND MEDICAL CENTER A NEW JERSEY NONPROFIT CORP | NJ | General Acute Care Hospital (282N00000X) |
United | 95991 | $470.00 | 1871596403 - CUMBERLAND MEDICAL CENTER, INC., CUMBERLAND MEDICAL CENTER | 620790132 - (TN) CUMBERLAND MEDICAL CENTER INC | TN | General Acute Care Hospital (282N00000X) |
United | 95991 | $1932.00 | 1669489571 - SEVENTH-DAY ADVENTISTS LOMA LINDA UNIVERSITY MEDICAL CENTER, LOMA LINDA UNIVERISTY MEDICAL CENTER | 953522679 - SEVENTH-DAY ADVENTISTS LOMA LINDA UNIVERSITY MEDICAL CENTER INC | CA | General Acute Care Hospital (282N00000X) |
United | 95991 | $1570.00 | 1275527889 - CANDLER HOSPITAL INCORPORATED | 580593388 - CANDLER HOSPITAL INCORPORATED | GA | General Acute Care Hospital (282N00000X) |
United | 95991 | $383.00 | 1528282639 - PIKE COUNTY MEMORIAL HOSPITAL | 436002764 - (MO) PIKE COUNTY MEMORIAL HOSPITAL | MO | Critical Access Hospital (282NC0060X) |
United | 95991 | $3224.00 | 1184159188 - HSS WESTCHESTER | 131624135 - NEW YORK SOCIETY FOR THE RELIEF OF RUPTURED & CRIPPLED MAINTAINING | NY | Radiology Clinic/Center (261QR0200X) |
United | 95991 | $1298.00 | 1952326977 - AMISUB (SFH), INC., ST. FRANCIS HOSPITAL | 752522262 | TN | General Acute Care Hospital (282N00000X) |
United | 95991 | $738.00 | 1801971965 - CARONDELET HEALTH NETWORK, ST MARY'S HOSPITAL | 474131755 | AZ | General Acute Care Hospital (282N00000X) |
United | 95991 | $530.00 | 1730692641 - THE HEALTH CARE AUTHORITY OF THE CITY OF EUFAULA, MEDICAL CENTER BARBOUR | 208104245 | AL | Critical Access Hospital (282NC0060X) |
United | 95991 | $3398.00 | 1215989611 - FAIRVIEW HOSPITAL, CLEVELAND CLINIC FOUNDATION FAIRVIEW HOSPITAL | 340714618 - FAIRVIEW HOSPITAL | OH | General Acute Care Hospital (282N00000X) |
United | 95991 | $746.00 | 1982629440 - EMANATE HEALTH MEDICAL CENTER, CITRUS VALLEY MEDICAL CENTER INTER-COMMUNITY CAMPUS | 956006469 - (CA) EMANATE HEALTH MEDICAL CENTER | CA | General Acute Care Hospital (282N00000X) |
United | 95991 | $9594.00 | 1467560599 - DIGNITY COMMUNITY CARE, METHODIST HOSPITAL OF SACRAMENTO | 721561131 | CA | General Acute Care Hospital (282N00000X) |
United | 95991 | $2833.00 | 1235183542 - CLEVELAND CLINIC HEALTH SYSTEM, SOUTH POINTE HOSPITAL | 340714593 - CLEVELAND CLINIC HEALTH SYSTEM EAST REGION | OH | 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 95991 vs. Other Neurology and Neuromuscular Procedures Codes
The CPT 95991 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 95991 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 95991. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 95991 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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