CPT 99056 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 | • None • 11 - Office • 20 - Urgent Care Facility |
| Common Modifiers | • None • 95 - Telemedicine - audio and video • 93 - Telemedicine - audio only |
| Complexity Level | Low |
National average reimbursement for CPT 99056 by major payers:
$22.31
$23.60
$16.55
$31.44
| 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 99056 | ||||||
United | 99056 | $29.47 | 1497080584 - ELIZABETH HOMAN | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 99056 | $29.47 | 1609239243 - MEGAN GINSBURG | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 99056 | $16.27 | 1205975448 - CHRISTOPHER JOHNSON | 371158318 - (IL) SOUTHERN ILLINOIS HEALTHCARE FOUNDATION INC | IL | Psychiatry Physician (2084P0800X) |
United | 99056 | $31.11 | 1891921367 - KAVITA THAKKAR | 363097297 - NORTHWESTERN MEMORIAL HEALTHCARE | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 99056 | $28.19 | 1710206545 - NEIL JARIWALA | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | TX | Psychiatry Physician (2084P0800X) |
United | 99056 | $31.17 | 1104082734 - JADA JOHNSON | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 99056 | $31.43 | 1508984907 - DAVID BERRIER | 362177139 - UNIVERSITY OF CHICAGO | IL | Psychiatry Physician (2084P0800X) |
United | 99056 | $117.31 | 1871912683 - LAUREN SCHUMACHER | 943281660 | IL | Psychiatry Physician (2084P0800X) |
United | 99056 | $30.55 | 1043254980 - NISHANT SHAH | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 99056 | $28.19 | 1326465436 - MUSADDIQ TARIQ | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | MS | Psychiatry Physician (2084P0800X) |
United | 99056 | $30.55 | 1497080584 - ELIZABETH HOMAN | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Psychiatry Physician (2084P0800X) |
United | 99056 | $33.40 | 1366890857 - STEVEN SHARP | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | OK | Psychiatry Physician (2084P0800X) |
United | 99056 | $29.55 | 1407807746 - SYED KHAN | 320552496 | IL | Psychiatry Physician (2084P0800X) |
United | 99056 | $117.31 | 1760502058 - P. DANIEL LE GRANGE | 943281660 | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 99056 | $29.27 | 1568956043 - REID ALLEY | 363167726 - (IL) RIVERSIDE HEALTH SYSTEM | PA | Psychiatry Physician (2084P0800X) |
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 99056 vs. Other Special Services, Procedures and Reports Codes
The CPT 99056 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 99056 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 99056. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99056 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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