CPT 99170 Fee Schedule
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 • Other Medicine Services and Procedures |
| Common Place of Service | • 11 - Office • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 59 - Distinct Procedural Service • 25 - Significant, separately identifiable E/M service same day |
| Complexity Level | Moderate |
National average reimbursement for CPT 99170 by major payers:
$199.75
$194.82
$192.76
$253.57
| 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 99170 | ||||||
United | 99170 | $463.73 | 1275981524 - ANNIE KAO | 43148394 - (MA) TUFTS MEDICAL CENTER PHYSICIANS ORGANIZATION INC | MA | Pediatrics Physician (208000000X) |
United | 99170 | $148.75 | 1992701346 - GEORGE KATEI | 920717538 | TX | Internal Medicine Physician (207R00000X) |
United | 99170 | $129.96 | 1982879359 - ARWA LAHERI | 272273286 - (TX) NAJMUDDIN KARIMJEE, MD | TX | Internal Medicine Physician (207R00000X) |
United | 99170 | $522.57 | 1316280274 - JOHN HOANG | 752613493 - TEXAS HEALTH PHYSICIANS GROUP | TX | Internal Medicine Physician (207R00000X) |
United | 99170 | $622.70 | 1821072463 - SHANNON SCOTT-VERNAGLIA | 42697983 - MASS GENERAL BRIGHAM INCORPORATED | MA | Pediatrics Physician (208000000X) |
United | 99170 | $309.64 | 1497976492 - DOROTHY CHEN | 237425849 - (MA) EAST BOSTON NEIGHBORHOOD HEALTH CENTER CORP | MA | Pediatrics Physician (208000000X) |
United | 99170 | $613.72 | 1578790028 - ERICH RENNER | 43320571 | MA | Pediatrics Physician (208000000X) |
United | 99170 | $543.71 | 1952379810 - DAVID HOWELL | 202022354 - VILLAGE PEDIATRICS, LLC | MA | Pediatrics Physician (208000000X) |
United | 99170 | $622.70 | 1821353798 - FIONA DANAHER | 42807148 - MASS GENERAL BRIGHAM INCORPORATED | MA | Pediatrics Physician (208000000X) |
United | 99170 | $543.71 | 1083241533 - ALEXANDRA MILLER | 43427393 - (MA) WALPOLE PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | 99170 | $308.69 | 1285717959 - QUALITY KIDS KARE, PC | 43106457 - (MA) QUALITY KIDS KARE, INC. | MA | Pediatrics Physician (208000000X) |
United | 99170 | $182.13 | 1699784736 - PARAG AMIN | 42743855 - (MA) CENTRE PEDIATRIC ASSOCIATES, P.C. | MA | Pediatrics Physician (208000000X) |
United | 99170 | $75.45 | 1942374681 - GRANT BECKHAM | 260297178 - (TX) PARK LANE MEDICAL GROUP PA | TX | Internal Medicine Physician (207R00000X) |
United | 99170 | $71.01 | 1255329561 - WARREN SIMI | 10568811 - (TX) WARREN W SIMI MD PA | TX | Internal Medicine Physician (207R00000X) |
United | 99170 | $613.72 | 1750630307 - JENISHA NANDHLAL | 42103881 - BETH ISRAEL DEACONESS MEDICAL CENTER INC | MA | Pediatrics Physician (208000000X) |
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 99170 vs. Other Other Medicine Services and Procedures Codes
The CPT 99170 code is part of the Medicine Services and Procedures services used for Other Medicine Services and Procedures. 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 99170 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 |
|---|---|---|
| 99075 | Low | Medical Testimony |
| 99078 | Low | Physician Or Other Qualified Health Care Professional Qualified By Education Training Licensure/Regulation (When Applicable) Educationalservices Rendered To Patients In A Group Setting (Eg Prenatal Obesity Or Diabetic Instructions) (Revised 01/01/13) |
| 99170 | Low | Anogenital Examination Magnified In Childhood For Suspected Trauma Including Image Recording When Performed (Revised 01/01/2014) |
| 99175 | Low | Ipecac Or Similar Administration For Individual Emesis And Continued Observation Until Stomach Adequately Emptied Of Poison |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99170. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99170 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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