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See a sample rate comparisonCPT 99116 Fee Schedule
CPT 99116 is classified under Medicine Services and Procedures, in the Qualifying Circumstances for Anesthesia subgroup.
Anesthesia Complicated By Util, Anesthesia Complicated By Utilization Of Total Bodyhypothermia (List Separately In Addition To Code For Primary Anesthesia Procedure)
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Qualifying Circumstances for Anesthesia |
| Common Place of Service | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital 11 - Office |
| Common Modifiers | 59 - Distinct Procedural Service GP - Services delivered under an outpatient physical therapy plan of care |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 99116 |
| Medicaid Fee Schedule | $17.36 median of the 7 states in the free preview · View Medicaid rates for 99116 |
National average reimbursement for CPT 99116 by major payers:
$185.58
BCBS / Anthem
$156.06
UnitedHealthcare
$256.58
Aetna
$290.11
Cigna
Compare published rates across providers.
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CPT 99116
5 of 25 sample ratesHigher to lower in this preview
Lisa Forrester
$465.00Published rateRyan Frederiksen
Professional Radiology, Inc.
$314.35Published rateRestorative Health Rehabilitation Inc
$60.00Published rateRestorative Health Rehabilitation Inc
$55.00Published rateCarlos Bazaldua
$32.40Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 99116 vs. Other Qualifying Circumstances for Anesthesia Codes
The table lists codes related to 99116. Select one to see its fee schedule.
| Code | Complexity | Description |
|---|---|---|
| 99100-CPT | Low | Anes Pt Exteme Age<1 Yr&>70, 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-CPT | Low | Anesthesia Complicated By Util, Anesthesia Complicated By Utilization Of Total Bodyhypothermia (List Separately In Addition To Code For Primary Anesthesia Procedure) |
| 99135-CPT | Low | Anesthesia Complicated By Util, Anesthesia Complicated By Utilization Of Controlledhypotension (List Separately In Addition To Code For Primary Anesthesia Procedure) |
| 99140-CPT | Low | Anesthesia Complicated By Emer, Anesthesia Complicated By Emergency Conditions (Specify)(List Separately In Addition To Code For Primary Anesthesia Procedure) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99116. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99116 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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