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See a sample rate comparisonCPT 99151 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.
Moderate Sedation Services Provided By The Same Physician Or Other Qualified Health Care Professional Performing The Diagnostic Or Therapeutic Service That The Sedation Supports Requiring The Presence Of An Independent Trained Observer To Assist In The Monitoring Of The Patients Level Of Consciousness And Physiologicalstatus; Initial 15 Minutes Of Intraservice Time Patient Younger Than 5 Years Of Age (Reinstated 01/01/2017).
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Moderate (Conscious) Sedation |
| Common Place of Service | 23 - Emergency Room 21 - Inpatient Hospital |
| Common Modifiers | 59 - Distinct Procedural Service GC - Service performed by resident under supervision |
| Complexity Level | Low |
| Medicare Fee Schedule | $62.13 national non-facility rate (2026) · View Medicare rates for 99151 |
| Medicaid Fee Schedule | $49.13 median of the 8 states in the free preview · View Medicaid rates for 99151 |
National average reimbursement for CPT 99151 by major payers:
$89.37
$96.36
$96.66
$119.58
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CPT 99151
5 of 25 sample ratesHigher to lower in this preview
Alexy Arauz Boudreau
Mass General Brigham Incorporated
$297.88Published rateJohn Knight
Kelsey-Seybold Medical Group PLLC
$164.27Published rateAudrey Guhn
Baystate Medical Practices Inc
$126.55Published rateHealthtexas Provider Network
$99.44Published rateKyle Lloyd
North Texas Internal Medicine Partners LLP
$20.54Published rate
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See a sample payer proposalCPT 99151 vs. Other Moderate (Conscious) Sedation Codes
The CPT 99151 code is part of the Medicine Services and Procedures services used for Moderate (Conscious) Sedation. 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 99151 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 |
|---|---|---|
| 99151-CPT | Low | Moderate Sedation Services Provided By The Same Physician Or Other Qualified Health Care Professional Performing The Diagnostic Or Therapeutic Service That The Sedation Supports Requiring The Presence Of An Independent Trained Observer To Assist In The Monitoring Of The Patients Level Of Consciousness And Physiologicalstatus; Initial 15 Minutes Of Intraservice Time Patient Younger Than 5 Years Of Age (Reinstated 01/01/2017). |
| 99152-CPT | Low | Moderate Sedation Services Provided By The Same Physician Or Other Qualified Health Care Professional Performing The Diagnostic Or Therapeutic Service That The Sedation Supports Requiring The Presence Of An Independent Trained Observer To Assist In The Monitoring Of The Patients Level Of Consciousness And Physiologicalstatus; Initial 15 Minutes Of Intraservice Time Patient Age 5 Years Or Older. (Reinstated 01/01/2017). |
| 99153-CPT | Low | Mod Sed Same Phys Qhp Ea, Moderate Sedation Services Provided By The Same Physician Or Other Qualified Health Care Professional Performing The Diagnostic Or Therapeutic Service That The Sedation Supports Requiring The Presence Of An Independent Trained Observer To Assist In The Monitoring Of The Patient S Level Of Consciousness And Physiological Status Each Additional 15 Minutes Intraservice Time List Separately In Addition To Code For Primary Service |
| 99155-CPT | Low | Mod Sed Oth Phys Qhp 5 Yrs, Moderate Sedation Services Provided By A Physician Or Other Qualified Health Care Professional Other Than The Physician Or Other Qualified Health Care Professional Performing The Diagnostic Or Therapeutic Service That The Sedation Supports Initial 15 Minutes Of Intraservice Time Patient Younger Than 5 Years Of Age |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99151. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99151 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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Frequently Asked Questions
To find out the cost of a specific medical procedure, you will need the CPT (Current Procedural Terminology) code for that service and your specific location. For detailed and localized fee schedule information, it is recommended to use Payerprice's fee schedule lookup tool. They allow you to search with a CPT code and specific location to get relevant pricing data. You should also contact your insurance provider to understand your coverage and out-of-pocket costs.
A CPT (Current Procedural Terminology) code is a standardized five-digit code used by medical professionals to describe medical, surgical, and diagnostic services. These codes are crucial for billing and reimbursement, as they determine what services were provided and thus significantly impact the cost calculation for a procedure or service. Understanding the CPT code for a service is the first step in researching its potential cost.
For looking up fee schedules for medical services, especially with specific CPT codes and locations, Payerprice offers a dedicated fee schedule lookup tool. This tool can provide detailed pricing information relevant to your specific situation, helping you understand potential costs before receiving a service.
Yes, to compare prices for healthcare services in your specific area, Payerprice's fee schedule lookup tool is highly recommended. You can input the CPT code for the service you need and your location to access relevant pricing data, which can help you compare costs and make informed decisions.
Understanding your medical bill involves reviewing several key components: the services provided (often listed with CPT codes), the charges for each service, the amount your insurance covered, and your remaining patient responsibility (deductibles, co-pays, co-insurance). If you have questions about specific charges or CPT codes on your bill, you can use tools like Payerprice's fee schedule lookup tool to research the typical costs for those services in your area, and then discuss any discrepancies with your provider's billing department or your insurance company.