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See a sample rate comparisonCPT 99116 Fee Schedule
Last Verified: September 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.
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 | None 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 | View Medicaid rates for 99116 |
National average reimbursement for CPT 99116 by major payers:
$185.58
$156.06
$256.58
$290.11
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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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See a sample payer proposalCPT 99116 vs. Other Qualifying Circumstances for Anesthesia Codes
The CPT 99116 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 99116 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 |
|---|---|---|
| 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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