CPT stands for Current Procedural Terminology. These are a standardized set of five-digit alphanumeric codes used by healthcare providers to describe medical, surgical, and diagnostic services provided to patients. They are essential for accurate billing and claims processing.

How can I find the cost of a medical procedure using a CPT code?

To find the cost of a specific medical procedure using a CPT code, you can use online tools that provide fee schedule lookups. For a detailed estimate based on your specific location and CPT code, you can utilize platforms like Payerprice. They offer a fee schedule lookup tool designed to help users search for procedure costs. It's also advisable to contact your healthcare provider's billing department directly for a personalized estimate and your insurance company to understand your out-of-pocket costs.

What is the difference between CPT and ICD-10 codes?

CPT (Current Procedural Terminology) codes describe the medical services or procedures performed by a healthcare provider. They answer 'what was done?'. ICD-10 (International Classification of Diseases, 10th Revision) codes, on the other hand, describe the diagnosis or reason for the patient's visit. They answer 'why was it done?' or 'what is the condition?'. Both types of codes are crucial for medical billing and record-keeping.

Does Payerprice provide information for all medical procedures?

Payerprice focuses on providing fee schedule lookup tools for a wide range of CPT codes and specific locations. While they aim to cover a comprehensive set of procedures, the exact scope of their data would be best confirmed by checking their platform or contacting their support directly.

How can I determine if my insurance will cover a specific CPT code?

To determine if your insurance will cover a specific CPT code, the most reliable method is to contact your insurance provider directly. You can find their contact information on your insurance card. Provide them with the CPT code(s) for the procedure you are inquiring about, your policy number, and any relevant medical necessity information. They can explain your benefits, coverage limitations, deductibles, co-pays, and pre-authorization requirements. You can also use Payerprice to understand typical costs, which can help in discussions with your insurer.

CPT 99078 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.

Group Health Education, Physician Or Other Qualified Health Care Professional Qualified By Education Training Licensure Regulation When Applicable Educational Services Rendered To Patients In A Group Setting Eg Prenatal Obesity Or Diabetic Instructions

Key Fact	Detail
Service Type	Medicine Services and Procedures Special Services, Procedures and Reports
Common Place of Service	11 - Office 22 - On Campus Outpatient Hospital
Common Modifiers	None TH 95 - Telemedicine - audio and video
Complexity Level	Low
Medicare Fee Schedule	View Medicare rates for 99078
Medicaid Fee Schedule	View Medicaid rates for 99078

National average reimbursement for CPT 99078 by major payers:

$46.74

$34.56

$27.81

$31.33

Compare published rates across providers.

Choose a payer to see a sample of rates for CPT 99078.

CPT 99078

5 of 25 sample ratesHigher to lower in this preview

Ram Balasubramanian
ALInterventional Cardiology PhysicianNPI 1831346006Tax ID 82-3898488
$68.73Published rate
Restorative Health Rehabilitation Inc
FLHome Health AgencyNPI 1649599168Tax ID 27-2533824
$60.00Published rate
All Ways Homecare Inc
FLHome Health AgencyNPI 1588756076Tax ID 20-2696236
$55.00Published rate
Restorative Health Rehabilitation Inc
FLHome Health AgencyNPI 1649599168Tax ID 27-2533824
$40.00Published rate
The Medical Center Of Central Georgia Inc, Atrium Health Navicent The Medical Center
Medical Center Of Central Georgia Inc
GAGeneral Acute Care HospitalNPI 1043270564Tax ID 58-2149128
$16.18Published rate

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Summit Women's CareDenver, Colorado

September 2, 2026

Contracting Manager
UnitedHealthcare
Commercial PPO

Re: Request for fee schedule renegotiation

We request a formal review of our Commercial PPO fee schedule. The comparison below summarizes our current rate alongside published rates for comparable Denver-area practices.

Market evidence · CPT 59485

Current rate: $152.40
Market median: $147.00
Market position: 61st percentile

The comparison includes 1,284 published rates from 96 provider groups, scoped to OB/GYN providers in a professional, office-based setting.

We would welcome a discussion of our fee schedule and the supporting July 2026 market analysis. Please let us know a suitable time to review the comparison together.

Sincerely,
Summit Women's Care

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CPT 99078 vs. Other Special Services, Procedures and Reports Codes

The CPT 99078 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 99078 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
99075-CPT	Low	Testimony For A Legal Case, Testimony By A Health Care Professional About Medical Care That Is Provided To A Medical Board In A Deposition Or As A Witness In A Court Case.
99078-CPT	Low	Group Health Education, Physician Or Other Qualified Health Care Professional Qualified By Education Training Licensure Regulation When Applicable Educational Services Rendered To Patients In A Group Setting Eg Prenatal Obesity Or Diabetic Instructions
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
99170-CPT	Low	Genital Exam Of Child, Exam Of The Anus And Genitals Of A Child With A Magnifying Scope (Colposcope). This Exam Is Given When Injury From Abuse Is Suspected.

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99078. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 99078 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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