CPT 99100 Fee Schedule
Last Updated: April 2025
Anesthesia For Patient Of Extreme Age, Younger Than 1 Year And Older Than 70 (List Separately In Addition To Code For Primary Anesthesia Procedure)
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 • Qualifying Circumstances for Anesthesia |
| Common Place of Service | • 22 - On Campus-Outpatient Hospital • 24 - Ambulatory Surgical Center • 21 - Inpatient Hospital |
| Common Modifiers | • None • AA - Anesthesia services performed personally by an anesthesiologist • GY - Notice of Liability Not Issued, Not Required Under Payer Policy. Used to report that an ABN was not issued because item or service is statutorily excluded or does not meet definition of any Medicare benefit |
| Complexity Level | Moderate |
National average reimbursement for CPT 99100 by major payers:
$46.28
$39.62
$91.53
$46.88
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99100. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99100 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.
CPT 99100 vs. Other Qualifying Circumstances for Anesthesia Codes
The CPT 99100 code is part of the Medicine Services and Procedures services used for Qualifying Circumstances for Anesthesia. 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 99100 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.
| CPT Code | Complexity Level | Description |
|---|---|---|
| 99100 | Low | Anesthesia For Patient Of Extreme Age, Younger Than 1 Year And Older Than 70 (List Separately In Addition To Code For Primary Anesthesia Procedure) |
| 99116 | Moderate | Anesthesia Complicated By Utilization Of Total Body Hypothermia (List Separately In Addition To Code For Primary Anesthesia Procedure) |
| 99135 | Low | Anesthesia Complicated By Utilization Of Controlled Hypotension (List Separately In Addition To Code For Primary Anesthesia Procedure) |
| 99140 | Low | Anesthesia Complicated By Emergency Conditions (Specify) (List Separately In Addition To Code For Primary Anesthesia Procedure) |
See what providers are getting paid in 2024 for 99100:
CPT 99100 Fee Schedule & Reimbursement Rates
The CPT 99100 fee schedule varies by payer type. Below are Medicare rates for 2024 and average in-network rates by state across major payers:
Reimbursement rates depend on provider contracts, region, and payer. Always verify rates with your insurance provider or medical billing department.
What is price transparency?
The Price Transparency Rule is a federal law that took effect in July 2022, requiring all commercial payers to publicly disclose their prices through machine-readable files (MRFs). In short, this regulation mandates that insurance companies make healthcare costs transparent to the public.
Our data comes directly from these insurer-posted MRFs, ensuring compliance with the Price Transparency Rule. While PayerPrice is working toward a future where providers and payers collaborate for 100% upfront price certainty, it's important to acknowledge that data limitations and occasional errors may exist.
Healthcare Price Transparency Rule
cms.govConsumer Guide To Healthcare Prices
aha.orgGlossary of Healthcare Terms
healthcare.govUnlock access to price transparency insights today.
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