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See a sample rate comparisonCPT 99072 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.
Addl Supl Matrl Staf Tm Phe, Additional Supplies Materials And Clinical Staff Time Over And Above Those Usually Included In An Office Visit Or Other Non Facility Service S When Performed During A Public Health Emergency As Defined By Law Due To Respiratory Transmitted Infectious Disease
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Special Services, Procedures and Reports |
| Common Place of Service | 11 - Office 20 - Urgent Care Facility |
| Common Modifiers | GP - Services delivered under an outpatient physical therapy plan of care 59 - Distinct Procedural Service |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 99072 |
| Medicaid Fee Schedule | View Medicaid rates for 99072 |
National average reimbursement for CPT 99072 by major payers:
$32.02
$30.41
$22.62
$132.59
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CPT 99072
5 of 25 sample ratesHigher to lower in this preview
All Ways Homecare Inc
$60.00Published rateAll Ways Homecare Inc
$55.00Published rateRestorative Health Rehabilitation Inc
$40.00Published rateDa Pediatric Rehabilitation
$40.00Published rateAll Ways Homecare Inc
$35.00Published rate
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See a sample payer proposalCPT 99072 vs. Other Special Services, Procedures and Reports Codes
The CPT 99072 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 99072 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 |
|---|---|---|
| 99070-CPT | Low | Special Supplies Phys Qhp, Supplies And Materials Except Spectacles Provided By The Physician Or Other Qualified Health Care Professional Over And Above Those Usually Included With The Office Visit Or Other Services Rendered List Drugs Trays Supplies Or Materials Provided |
| 99071-CPT | Low | Patient Education Materials, Educational Supplies Such As Books Tapes And Pamphlets For The Patient S Education At Cost To Physician Or Other Qualified Health Care Professional |
| 99072-CPT | Low | Addl Supl Matrl Staf Tm Phe, Additional Supplies Materials And Clinical Staff Time Over And Above Those Usually Included In An Office Visit Or Other Non Facility Service S When Performed During A Public Health Emergency As Defined By Law Due To Respiratory Transmitted Infectious Disease |
| 99080-CPT | Low | Special Reports Such As Insura, Special Reports Such As Insurance Forms More Thantheinformation Conveyed In The Usual Medical Comm Unications Or Standard Reporting Form |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99072. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99072 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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