CPT 99152 Fee Schedule
Last Updated: April 2025
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).
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 • Moderate (Conscious) Sedation |
| Common Place of Service | • 22 - On Campus-Outpatient Hospital • 21 - Inpatient Hospital |
| Common Modifiers | • None • 59 - Distinct Procedural Service • XU - Unusual Non-Overlapping Service, the use of a service that is distinct because it does not overlap usual components of the main service |
| Complexity Level | Moderate |
National average reimbursement for CPT 99152 by major payers:
$64.55
$65.37
$71.05
$90.48
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99152. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99152 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 99152 vs. Other Moderate (Conscious) Sedation Codes
The CPT 99152 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 99152 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 |
|---|---|---|
| 99151 | 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 | 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 | Low | Moderate Sedation Services Provided By The Same Physician Or Other Qualified Health Careprofes- Sional 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 Levelof Consciousness And Physiological Status; Each Additional 15 Minutes Intraservice Time (List Se- Parately In Addition To Code For Primary Service) |
| 99155 | Low | Moderate Sedation Services Provided By A Physicianor Other Qualified Health Careprofessional Other Than The Physician Or Other Qualified Health Care Professional Performing The Diagnostic Or Thera- Peutic Service That The Sedation Supports; Initial15 Minutes Of Intraservice Time Patient Younger Than 5 Years Of Age |
See what providers are getting paid in 2024 for 99152:
CPT 99152 Fee Schedule & Reimbursement Rates
The CPT 99152 fee schedule varies by payer type. Below are Medicare rates for 2024 and average in-network rates by state across major payers:
| Code | Medicare Rate | Avg. Cigna National Rate | More Info |
|---|---|---|---|
| 99151 | $60.58 | $119.58 | |
| 99152 | $50.26 | $90.48 | |
| 99153 | $11.65 | $27.02 | |
| 99155 | $81.55 | $145.44 | |
| 99156 | $73.90 | $128.52 | |
| 99157 | $58.59 | $103.45 |
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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