CPT 99091 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 | • 11 - Office • 99 - Other POS |
| Common Modifiers | • None • 52 - Reduced Services • 25 - Significant, separately identifiable E/M service same day |
| Complexity Level | Low |
National average reimbursement for CPT 99091 by major payers:
$69.06
$71.70
$67.78
$88.38
| 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 99091 | ||||||
United | 99091 | $91.73 | 1225534258 - HAITHAM RAHMAN | 363314159 - (NE) REGIONAL WEST PHYSICIANS CLINIC | TX | Internal Medicine Physician (207R00000X) |
United | 99091 | $138.36 | 1891723912 - IHAB HAJJAR | 954540991 - USC CARE MEDICAL GROUP INC | TX | Neurology Physician (2084N0400X) |
United | 99091 | $113.63 | 1740281302 - SCOTT MCKINSTRY | 752616977 - CHRISTUS TRINITY CLINIC | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99091 | $76.16 | 1538118823 - TEXAS TECH UNIVERSITY HEALTH SCIENCES CENTER LUBBOCK, TTUHSC -INTERNAL MEDICINE | 752668018 | TX | Internal Medicine Physician (207R00000X) |
United | 99091 | $67.18 | 1104922988 - DANIEL KRAMPITZ | 751667190 - (TX) NEUROLOGY CONSULTANTS OF DALLAS, P.A. | TX | Neurology Physician (2084N0400X) |
United | 99091 | $165.75 | 1932640208 - SARA DOYLE | 201508867 | TX | Neurology Physician (2084N0400X) |
United | 99091 | $76.86 | 1780781427 - RAMIL JUMAO-AS | 271172405 - (TX) COMPREHENSIVE HOSPITALIST SERVICES OF TEXAS PLLC | TX | Internal Medicine Physician (207R00000X) |
United | 99091 | $82.73 | 1205124971 - CAROLINA OJEDA FLORES | 752600873 - (TX) SHANNON CLINIC | TX | Internal Medicine Physician (207R00000X) |
United | 99091 | $78.98 | 1720077084 - LEIGH JENKINS | 752668014 | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99091 | $44.09 | 1750489258 - ZACHARY SMITH | 760483565 - (TX) SMITH KLEIN PA | TX | Internal Medicine Physician (207R00000X) |
United | 99091 | $68.06 | 1750362919 - ELI MIZRAHI | 300791563 | TX | Neurology Physician (2084N0400X) |
United | 99091 | $68.04 | 1144213869 - SURYA LANKA | 752497784 - SURYA P. LANKA, M.D. | TX | Internal Medicine Physician (207R00000X) |
United | 99091 | $72.23 | 1619137015 - LAKSHMI MUKUNDAN | 640662976 - NORTH MISSISSIPPI MEDICAL CENTER INC | TX | Neurology Physician (2084N0400X) |
United | 99091 | $76.27 | 1518167188 - SHERIF LATIF | 271371893 | TX | Internal Medicine Physician (207R00000X) |
United | 99091 | $100.44 | 1730575200 - SAMUEL ELEANYA | 364709524 - (LA) ST FRANCIS MEDICAL GROUP LLC | TX | Internal Medicine Physician (207R00000X) |
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 99091 vs. Other Special Services, Procedures and Reports Codes
The CPT 99091 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 99091 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 |
|---|---|---|
| 99001-CPT | Low | Handling And/Or Conveyance Of Specimen For Transfer From The Patient In Other Than An Office To A Laboratory (Distance May Be Indicated) (Revised 01/01/13) |
| 99002-CPT | Low | Handling Conveyance And/Or Any Other Service In Connection With The Implementation Of An Order Involving Devices (Eg Designing Fitting Packaging Handling Delivery Or Mailing) When Devices Such As Orthotics Protectives Prostheticare Fabricated By An Outside Laboratory Or Shop But Which Items Have Been Designed And Are To Be Fitted And Adjusted By The Attending Physician Or Other Qualified Health Care Professional (Revised 01/01/13) |
| 99070-CPT | Low | 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 Ormaterials Provided) (Revised 01/01/13) |
| 99091-CPT | Low | Collection And Interpretation Of Physiologic Data (Eg Ecg Blood Pressure Glucose Monitoring) Digitally Stored And/Or Transmitted By The Patientand/Or Caregiver To The Physician Or Other Quali- Fied Health Care Professional Qualified By Edu- Cation Training Licensure/Regulation (When Ap- Plicable) Requiring A Minimum Of 30 Minutes Of Time Each 30 Days (Desc Rvsd 1/1/19) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99091. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99091 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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