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See a sample rate comparisonCPT 99058 Fee Schedule
Last Verified: September 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.
Office Emergency Care, Service S Provided On An Emergency Basis In The Office Which Disrupts Other Scheduled Office Services In Addition To Basic Service
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Special Services, Procedures and Reports |
| Common Place of Service | 11 - Office 20 - Urgent Care Facility 81 - Independent Laboratory |
| Common Modifiers | None 59 - Distinct Procedural Service 25 - Significant, separately identifiable E/M service same day |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 99058 |
| Medicaid Fee Schedule | View Medicaid rates for 99058 |
National average reimbursement for CPT 99058 by major payers:
$33.64
$29.15
$92.62
$37.32
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CPT 99058
5 of 25 sample ratesHigher to lower in this preview
P. Daniel Le Grange
$146.85Published rateJames Mackenzie
Advocate Health And Hospitals Corporation
$44.47Published rateMalik Nassan
Head & Neck And Cosmetic Surgery Associates, LLC
$38.56Published rateLekshmi Venugopal
Edward Health Ventures
$34.65Published rateOyoyo Sawyer
District Medical Group Inc
$17.69Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 99058 vs. Other Special Services, Procedures and Reports Codes
The CPT 99058 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 99058 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. |
| 99058-CPT | Low | Office Emergency Care, Service S Provided On An Emergency Basis In The Office Which Disrupts Other Scheduled Office Services 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 99058. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99058 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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