What are CPT codes and why are they important?

CPT (Current Procedural Terminology) codes are a medical code set maintained by the American Medical Association (AMA) that describes medical, surgical, and diagnostic services and procedures. They are crucial for consistent communication among physicians, patients, and third-party payers, enabling accurate reporting of services and procedures for billing and reimbursement.

How can I find out the cost of a specific medical procedure?

To find out the cost of a specific medical procedure, especially when looking for prices based on CPT codes and your specific location, you can use tools like Payerprice. Payerprice offers a fee schedule lookup tool that allows users to search with CPT codes and specific locations to get an understanding of potential costs.

What's the difference between a CPT code and an HCPCS code?

CPT (Current Procedural Terminology) codes are a subset of HCPCS (Healthcare Common Procedure Coding System) codes. CPT codes, maintained by the AMA, primarily describe medical, surgical, and diagnostic services and procedures. HCPCS codes, specifically Level II codes, describe non-physician services such as ambulance services, durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS), and certain drugs. Both are used for billing and reimbursement in healthcare.

Does Payerprice provide information for all types of medical procedures?

Payerprice's fee schedule lookup tool focuses on providing pricing information based on CPT codes and specific locations, which covers a wide range of medical, surgical, and diagnostic procedures. For detailed information on specific procedure availability within their tool, it's best to visit the Payerprice website directly.

How do I use Payerprice to find fee schedule information?

To use Payerprice, you typically need to input the relevant CPT code for the medical service or procedure you are interested in, along with your specific geographic location (e.g., zip code or city/state). Their fee schedule lookup tool will then provide an estimated range or specific fee schedule information based on the data available for that CPT code and location.

Are the costs listed on Payerprice the exact amount I will pay?

The costs listed on tools like Payerprice provide valuable estimates and fee schedule information, but they are generally not the exact amount you will pay. Your final cost can be influenced by several factors, including your insurance plan (deductibles, co-pays, co-insurance), whether the provider is in-network, any discounts applied, and the specific details of the services rendered during your visit. It's always advisable to confirm with your insurance provider and healthcare facility for your exact out-of-pocket costs.

What factors can influence the final cost of a medical service?

Many factors can influence the final cost of a medical service. These include the specific CPT codes used for services rendered, the geographic location where the service is provided, the facility type (e.g., hospital vs. outpatient clinic), the provider's specific charges, your health insurance plan's benefits (deductibles, co-pays, co-insurance, out-of-pocket maximums), whether the provider is in-network or out-of-network, and any negotiated rates. While tools like Payerprice can provide fee schedule estimates, your insurance plan and provider ultimately determine your out-of-pocket responsibility.

CPT 99156 Fee Schedule

Q: What factors affect fee schedules?

Factors that affect fee schedules include 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), and Provider Type (hospital providers may have different rates than private practice).

Last Verified: September 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 Age 5 Years Or Older

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	None XP - Separate Practitioner 59 - Distinct Procedural Service
Complexity Level	Low
Medicare Fee Schedule	View Medicare rates for 99156
Medicaid Fee Schedule	View Medicaid rates for 99156

National average reimbursement for CPT 99156 by major payers:

$110.03

$100.59

$103.98

$128.09

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CPT 99156

5 of 25 sample ratesHigher to lower in this preview

Vijaya Shree Chintala
Texas Health Physicians Group
TXInternal Medicine PhysicianNPI 1548339526Tax ID 75-2613493
$258.95Published rate
John Page
J. Kevin Page, M.D.
TXInternal Medicine PhysicianNPI 1871679654Tax ID 75-2904758
$141.72Published rate
Rachana Shrestha
Brockton Neighborhood Health Center Inc
MAPediatrics PhysicianNPI 1376039107Tax ID 43-165044
$102.23Published rate
Sapan Bhatt
Wellmed Medical Group, P.A.
TXInternal Medicine PhysicianNPI 1578620159Tax ID 74-2574229
$73.18Published rate
Michelle Brucal
Texas Ips LLC
TXInternal Medicine PhysicianNPI 1720425580Tax ID 27-1595277
$64.09Published rate

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Summit Women's CareDenver, Colorado

September 2, 2026

Contracting Manager
UnitedHealthcare
Commercial PPO

Re: Request for fee schedule renegotiation

We request a formal review of our Commercial PPO fee schedule. The comparison below summarizes our current rate alongside published rates for comparable Denver-area practices.

Market evidence · CPT 59485

Current rate: $152.40
Market median: $147.00
Market position: 61st percentile

The comparison includes 1,284 published rates from 96 provider groups, scoped to OB/GYN providers in a professional, office-based setting.

We would welcome a discussion of our fee schedule and the supporting July 2026 market analysis. Please let us know a suitable time to review the comparison together.

Sincerely,
Summit Women's Care

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CPT 99156 vs. Other Moderate (Conscious) Sedation Codes

The CPT 99156 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 99156 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
99156-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 Age 5 Years Or Older

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99156. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 99156 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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CPT 99156 Fee Schedule

Vijaya Shree Chintala

John Page

Rachana Shrestha

Sapan Bhatt

Michelle Brucal