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See a sample rate comparisonCPT 99056 Fee Schedule
Last Verified: October 2026
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.
Services Provided At Request O, Services Provided At Request Of Patient In A Location Other Than Physicians Office Which Are Normally Provided In The Office
| 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 |
| Medicare Fee Schedule | View Medicare rates for 99056 |
| Medicaid Fee Schedule | View Medicaid rates for 99056 |
National average reimbursement for CPT 99056 by major payers:
$22.31
$23.60
$16.55
$31.29
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CPT 99056
5 of 25 sample ratesHigher to lower in this preview
Alma Bicknese
Pediatric Faculty Foundation In
$52.43Published rateAniruddha Deka
$32.56Published rateSamantha Patel
$30.23Published rateBradley Weisner
Urology Specialists Of The Carolinas, PLLC
$25.68Published rateClint Anthony
District Medical Group Inc
$14.21Published rate
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See a sample payer proposalCPT 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 | Medical Services After Hrs, 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 | Additional Office Services, Additional Services Beyond Those Typically Offered Provided In The Physician Office During Regular Extended Hours Such As Evenings Or Weekends. |
| 99053-CPT | Low | After Hours Services, After Hours Services Are Provided In The Doctors Office Outside Typical Business Hours But At Times An Office Is Open. This May Include Hours On Sundays And Holidays Or Late At Night. |
| 99056-CPT | Low | Services Provided At Request O, Services Provided At Request Of Patient In A Location Other Than Physicians Office Which Are Normally Provided In The Office |
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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