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See a sample rate comparisonCPT 99155 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.
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
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Moderate (Conscious) Sedation |
| Common Place of Service | 23 - Emergency Room 22 - On Campus Outpatient Hospital |
| Common Modifiers | 59 - Distinct Procedural Service GC - Service performed by resident under supervision |
| Complexity Level | Low |
| Medicare Fee Schedule | $81.50 national non-facility rate (2026) · View Medicare rates for 99155 |
| Medicaid Fee Schedule | $64.825 median of the 8 states in the free preview · View Medicaid rates for 99155 |
National average reimbursement for CPT 99155 by major payers:
$125.77
$116.21
$118.02
$144.84
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CPT 99155
5 of 25 sample ratesHigher to lower in this preview
Yamini Sharma
$420.98Published rateJulian Huang
Healthcare South, PC
$197.11Published rateOluwakemi Fagbami
Kootenai Health Inc
$131.50Published rateWilliam Holland
Bsa Physicians Group Inc
$111.12Published rateMichelle Anderson
$70.62Published rate
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See a sample payer proposalCPT 99155 vs. Other Moderate (Conscious) Sedation Codes
The CPT 99155 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 99155 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 99155. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99155 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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