CPT 99172 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 • None • 71 - Public Health Clinic |
| Common Modifiers | • None • EP - Residential facility to Physician's office • 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
National average reimbursement for CPT 99172 by major payers:
$32.95
$22.54
$21.12
$31.15
| 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 99172 | ||||||
United | 99172 | $18.55 | 1548324163 - SUPRIYA THIRUNARAYANAN | 471400922 | TX | Neurology Physician (2084N0400X) |
United | 99172 | $26.37 | 1922164664 - MARINA TREVINO | 746000756 - (TX) EL PASO COUNTY HOSPITAL DISTRICT | TX | Internal Medicine Physician (207R00000X) |
United | 99172 | $21.12 | 1740280510 - ALEKSANDRA OLSSON-DETWILER | 752951355 - (TX) TEXAS SPINE AND JOINT HOSPITAL | TX | Internal Medicine Physician (207R00000X) |
United | 99172 | $33.77 | 1093914962 - DEEPA MOPARTY | 752582845 | TX | Internal Medicine Physician (207R00000X) |
United | 99172 | $15.90 | 1346424652 - SYED ATHER YUSOOF MD PA | 742860653 - (TX) SYED A. YUSOOF, M.D., P.A. | TX | Internal Medicine Physician (207R00000X) |
United | 99172 | $22.94 | 1841246113 - RIM BANNOUT | 352526373 - ACCLAIM PHYSICIAN GROUP INC | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99172 | $20.86 | 1699156273 - ELLIANA WIESNER | 452654166 | TX | Internal Medicine Physician (207R00000X) |
United | 99172 | $14.14 | 1245682020 - PAUL BONGAT | 50592086 - (TX) ADRIANA POP-MOODY, MD, CLINIC, PA | TX | Internal Medicine Physician (207R00000X) |
United | 99172 | $32.29 | 1114983061 - JAYASREE KAILASAM | 813432660 - (TX) DEEPA CHINTALA MD PA | TX | Internal Medicine Physician (207R00000X) |
United | 99172 | $60.81 | 1538516059 - ROBIN JACOB | 760386391 - KELSEY-SEYBOLD MEDICAL GROUP PLLC | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99172 | $18.87 | 1891824868 - MEADOWS PEDIATRICS PC | 43399671 - (MA) MEADOWS PEDIATRICS PC | MA | Pediatrics Physician (208000000X) |
United | 99172 | $33.77 | 1518216357 - MERIN VARGHESE | 752536818 - HEALTHTEXAS PROVIDER NETWORK | TX | Internal Medicine Physician (207R00000X) |
United | 99172 | $26.37 | 1932495256 - ANGELICA NUNEZ | 746000756 - (TX) EL PASO COUNTY HOSPITAL DISTRICT | TX | Internal Medicine Physician (207R00000X) |
United | 99172 | $22.15 | 1356320378 - TAMARA BARSIK | 752867667 - (TX) INPATIENT PHYSICIAN ASSOCIATES | TX | Internal Medicine Physician (207R00000X) |
United | 99172 | $56.20 | 1033506332 - AKWAUGO UZOEGWU | 470765154 - ALEGENT CREIGHTON CLINIC | TX | Internal Medicine Physician (207R00000X) |
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 99172 vs. Other Other Medicine Services and Procedures Codes
The CPT 99172 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 99172 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 |
|---|---|---|
| 99170 | Low | Anogenital Examination Magnified In Childhood For Suspected Trauma Including Image Recording When Performed (Revised 01/01/2014) |
| 99172 | Low | Visual Function Screening Automated Or Semi-Automated Bilateral Quantitative Determination Of Visual Acuity Ocular Alignment Color Vision By Pseudoisochromatic Plates And Field Of Vision (May Include All Or Some Screening Of The Determination(S) For Contrast Sensitivity Vision Under Glare) |
| 99173 | Low | Screening Test Of Visual Acuity, Quantitative, Bilateral (The Screening Test Used Must Employ Graduated Visual Acuity Stimuli That Allowa A Quantitative Estimate Of Visual Acuity (Eg. Snellen Chart), Other Identifiable Services Unrelated To This Screening Test Prov |
| 99174 | Low | Instrument-Based Ocular Screening (Eg Photoscreening Automated-Refraction) Bilateral; With Remote Analysis And Report (Revised 01/01/2016) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99172. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99172 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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