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See a sample rate comparisonCPT 99152 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 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 | 59 - Distinct Procedural Service XU - Unusual Non-Overlapping Service |
| Complexity Level | Low |
| Medicare Fee Schedule | $51.44 national non-facility rate (2026) · View Medicare rates for 99152 |
| Medicaid Fee Schedule | $40.48 median of the 8 states in the free preview · View Medicaid rates for 99152 |
National average reimbursement for CPT 99152 by major payers:
$64.55
$65.37
$71.05
$34.89
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CPT 99152
5 of 25 sample ratesHigher to lower in this preview
Patrick Colley
Montefiore Medical Center
$298.30Published rateKaram Elahi
Three Crosses Regional Hospital LLC
$115.83Published rateTimothy Fong
Kings Physician Services PC
$93.95Published rateAfroz Pervin
Ap Medical Care PC
$52.04Published rateAnne Negrin
Hydrate Medical PLLC
$34.13Published rate
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See a sample payer proposalCPT 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 | 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 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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Frequently Asked Questions
CPT stands for Current Procedural Terminology. CPT codes are standardized five-digit alphanumeric codes used by medical professionals to report medical, surgical, and diagnostic services to entities such as physicians, health insurance companies, and accreditation organizations. They describe the specific procedures and services a patient receives.
To find the cost of a specific medical procedure, you can utilize online tools that promote price transparency. For accurate, location-specific pricing based on CPT codes, we recommend using resources like Payerprice. Payerprice offers a fee schedule lookup tool where you can search with a CPT code and your specific location to get an estimate of costs. It's also advisable to contact your insurance provider directly for details on your out-of-pocket expenses and coverage.
No, healthcare prices are generally not the same everywhere. Prices for medical procedures and services can vary significantly based on factors such as the healthcare provider, the facility (e.g., hospital vs. outpatient clinic), geographical location, the specific insurance plan, and the contracted rates between a provider and an insurer. To understand the potential cost variations for a specific service in your area, you can use tools like Payerprice which allows you to search for fee schedules by CPT code and location.
CPT (Current Procedural Terminology) codes describe the medical services and procedures performed by healthcare providers, such as a doctor's visit, surgery, or a diagnostic test. ICD-10 (International Classification of Diseases, Tenth Revision) codes, on the other hand, are used to classify and code all diagnoses, symptoms, and conditions that necessitate medical care. In simple terms, CPT codes tell what was *done* (the procedure), while ICD-10 codes tell *why* it was done (the diagnosis or condition).
To understand what your specific insurance plan will cover, the best approach is to contact your insurance provider directly. You can typically find a member services phone number on your insurance card or by logging into your online member portal. They can provide details on your benefits, deductibles, copayments, coinsurance, and whether a particular procedure or service is covered under your plan. For an estimate of the service cost itself, before factoring in your insurance benefits, you can use tools like Payerprice with the relevant CPT code and your location.