CPT 99152 Fee Schedule

Last Verified: November 2025

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 Age 5 Years Or Older. (Reinstated 01/01/2017).

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
Complexity Level	Low

National average reimbursement for CPT 99152 by major payers:

$64.55

$65.37

$71.05

$90.48

Preview provider-level rates for...

For billing codeCPT 99152

Payer	Code	Rate	NPI	Tax ID	State	Specialty
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 99152
United	99152	$114.61	1366945180 - KHIN MYAT	133843560 - CRYSTAL RUN HEALTHCARE PHYSICIANS, LLP	NY	Hospitalist Physician (208M00000X)
United	99152	$134.71	1912481011 - CIHAN DUZGOL	845113455 - (MA) MW RADIOLOGYCRA LLC	NY	Body Imaging Physician (2085B0100X)
United	99152	$107.06	1366945180 - KHIN MYAT	133843560 - CRYSTAL RUN HEALTHCARE PHYSICIANS, LLP	NY	Hospitalist Physician (208M00000X)
United	99152	$105.43	1740817063 - TONY CONIGLIARO	453023019 - NORTH SHORE-LIJ MEDICAL PC	NY	Family Medicine Physician (207Q00000X)
United	99152	$98.78	1366945180 - KHIN MYAT	133843560 - CRYSTAL RUN HEALTHCARE PHYSICIANS, LLP	NY	Hospitalist Physician (208M00000X)
United	99152	$115.83	1043880917 - KARAM ELAHI	852388743 - (NM) THREE CROSSES REGIONAL HOSPITAL LLC	NY	Internal Medicine Physician (207R00000X)
United	99152	$298.30	1003262015 - BENJAMIN HAYES	131740114 - MONTEFIORE MEDICAL CENTER	NY	Internal Medicine Physician (207R00000X)
United	99152	$134.71	1194780759 - MATTHEW SPENCER	845113455 - (MA) MW RADIOLOGYCRA LLC	NY	Diagnostic Radiology Physician (2085R0202X)
United	99152	$115.83	1386221141 - SHIZA AKHTAR	852388743 - (NM) THREE CROSSES REGIONAL HOSPITAL LLC	NY	Internal Medicine Physician (207R00000X)
United	99152	$107.06	1003816604 - NANCY LINNEMAN	133843560 - CRYSTAL RUN HEALTHCARE PHYSICIANS, LLP	NY	Pulmonary Disease Physician (207RP1001X)
United	99152	$55.63	1215127170 - AFROZ PERVIN	832524941 - (NY) AP MEDICAL CARE PC	NY	Internal Medicine Physician (207R00000X)
United	99152	$89.52	1831531995 - ANIQA KOHEN	541519724 - RIVERSIDE HEALTHCARE ASSOCIATION INC	NY	Gastroenterology Physician (207RG0100X)
United	99152	$114.13	1306830732 - IRA BREITE	611661781	NY	Gastroenterology Physician (207RG0100X)
United	99152	$104.48	1043416407 - KUNWARDEEP SOHAL	461322238	NY	Gastroenterology Physician (207RG0100X)
United	99152	$42.84	1841608601 - FIVE TOWNS GASTROENTEROLOGY	460697666 - (NY) FIVE TOWNS GASTROENTEROLOGY PC	NY	Gastroenterology Physician (207RG0100X)
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist

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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.

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	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-CPT	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

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.

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