CPT 99053 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 • Special Services, Procedures and Reports |
| Common Place of Service | • 23 - Emergency Room • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • GC - Service performed by resident under supervision • AQ - Service in Health Professional Shortage Area |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 99053 |
National average reimbursement for CPT 99053 by major payers:
$23.79
$23.59
$12.85
$42.01
| 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 99053 | ||||||
United | 99053 | $23.94 | 1700055035 - HEATHER BRIDGE | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | FL | Surgical Physician Assistant (363AS0400X) |
United | 99053 | $27.35 | 1033435664 - SMITH OF GEORGIA, SMITH NORTHVIEW HOSPITALISTS | 271652335 - (GA) SMITH OF GEORGIA | GA | General Acute Care Hospital (282N00000X) |
United | 99053 | $27.62 | 1295992774 - KUN JIANG | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | FL | Anatomic Pathology & Clinical Pathology Physician (207ZP0102X) |
United | 99053 | $23.94 | 1174181929 - CHRISTOPHER RAY | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | FL | Medical Physician Assistant (363AM0700X) |
United | 99053 | $23.46 | 1144915778 - LEANNE ZAHN | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | FL | Single Specialty Group (193400000X) |
United | 99053 | $23.94 | 1588177919 - LINDSEY CHEVRIER | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | FL | Family Nurse Practitioner (363LF0000X) |
United | 99053 | $27.62 | 1396002788 - ARASH NAGHAVI | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | FL | Radiation Oncology Physician (2085R0001X) |
United | 99053 | $23.46 | 1851306203 - COLLETTE WEBSTER-WATSON | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | FL | Physician Assistant (363A00000X) |
United | 99053 | $23.46 | 1417504077 - BRITTANY PETTENGER | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | FL | Physician Assistant (363A00000X) |
United | 99053 | $23.94 | 1669921813 - SHAZIA MITHA | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | FL | Nurse Practitioner (363L00000X) |
United | 99053 | $23.46 | 1174871735 - JENNIFER LECKY | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | FL | Medical Physician Assistant (363AM0700X) |
United | 99053 | $27.62 | 1427347400 - TIMOTHY ROBINSON | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | FL | Radiation Oncology Physician (2085R0001X) |
United | 99053 | $28.17 | 1194103648 - MARTEN BASTA | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | FL | Plastic Surgery Physician (208200000X) |
United | 99053 | $23.46 | 1720574296 - SHANNEN WHIDDON | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | FL | Family Nurse Practitioner (363LF0000X) |
United | 99053 | $23.46 | 1366926958 - ELIZABETH SMITH | 593238640 - H LEE MOFFITT CANCER CTR & RES INST LIFE TIME CANCER SCRN CTR INC | FL | Nurse Practitioner (363L00000X) |
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 99053 vs. Other Special Services, Procedures and Reports Codes
The CPT 99053 code is part of the Medicine Services and Procedures services used for Special Services, Procedures and Reports. 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 99053 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 |
|---|---|---|
| 99050-CPT | Low | Services Provided In The Office At Times Other Than Regularly Scheduled Office Hours, Or Days When The Office Is Normally Closed (Eg, Holidays, Saturday Or Sunday), In Addition To Basic Service |
| 99051-CPT | Low | Service(S) Provided In The Office During Regularly Weekend, Or Holiday Office Hours, In Addition To Basic Service Medicaid Level Of Care 4, As Defined By Each State |
| 99053-CPT | Low | Svr Provided Between 10 Pm & 8 Am At 24hr Facility In Addition To Basic Service |
| 99056-CPT | Low | Service(S) Typically Provided In The Office, Provided Out Of The Office At Request Of Patient, In Addition To Basic Service |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99053. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99053 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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