CPT 99173 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 50 - Federally Qualified Health Center |
| Common Modifiers | None 59 - Distinct Procedural Service EP - Residential facility to Physician's office |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 99173 |
National average reimbursement for CPT 99173 by major payers:
$4.56
$4.47
$4.34
$6.43
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 99173 | $5.28 | 1215229349 - MINA FARKHONDEH | 42470906 - (MA) PIONEER VALLEY PEDIATRICS, INC. | MA | Pediatrics Physician (208000000X) |
United | 99173 | $3.79 | 1386632776 - LUIS SABATINI | 860828589 | TX | Internal Medicine Physician (207R00000X) |
United | 99173 | $3.48 | 1003346644 - MIYSHA GIRARDEAU | 741613878 - (TX) BAYLOR COLLEGE OF MEDICINE | TX | Internal Medicine Physician (207R00000X) |
United | 99173 | $7.40 | 1255319604 - LAZAROS XANTHOPOULOS | 42697983 - MASS GENERAL BRIGHAM INCORPORATED | MA | Pediatrics Physician (208000000X) |
United | 99173 | $6.92 | 1720441132 - JEREMY SLOSBERG | 43397450 - (MA) ATRIUS HEALTH, INC. | MA | Pediatrics Physician (208000000X) |
United | 99173 | $4.34 | 1982898631 - KELLY O'BRIEN | 741181532 - (TX) MEDICAL CLINIC OF HOUSTON, LLP | TX | Internal Medicine Physician (207R00000X) |
United | 99173 | $3.44 | 1770528010 - ALBERTO FLORES | 1770528010 - (TX) ALBERTO FLORES | TX | Internal Medicine Physician (207R00000X) |
United | 99173 | $4.92 | 1982662367 - FAISAL SYED | 742082653 - (TX) AUSTIN HEART, P.A. | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99173 | $2.30 | 1043218845 - PATRICIA SALVATO | 760324894 - (TX) DIVERSIFIED MEDICAL PRACTICES, P.A. | TX | Internal Medicine Physician (207R00000X) |
United | 99173 | $3.98 | 1023342748 - LOTIKA SINGH | 113149701 - (NY) GARDEN CITY DERMATOLOGY PC | TX | Internal Medicine Physician (207R00000X) |
United | 99173 | $3.60 | 1184617417 - ALAN MCBRIDE | 831683025 - (TX) GAINESVILLE COMMUNITY HOSPITAL INC | TX | Internal Medicine Physician (207R00000X) |
United | 99173 | $45.00 | 1073741518 - OYEBOLA OLADIRAN | 204700877 | TX | Internal Medicine Physician (207R00000X) |
United | 99173 | $3.21 | 1225320070 - EBERE OKEKE | 810755534 - (TX) EBEZOR ASSOCIATES LLC | TX | Internal Medicine Physician (207R00000X) |
United | 99173 | $5.40 | 1376986760 - CHRISTINA RAWANA | 141338544 - SAMARITAN HOSPITAL | TX | Internal Medicine Physician (207R00000X) |
United | 99173 | $7.38 | 1942291679 - LISA GRUBER | 43236175 - MASS GENERAL BRIGHAM INCORPORATED | 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 99173 vs. Other Other Medicine Services and Procedures Codes
The CPT 99173 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 99173 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-CPT | Low | Genital Exam Of Child, Exam Of The Anus And Genitals Of A Child With A Magnifying Scope (Colposcope). This Exam Is Given When Injury From Abuse Is Suspected. |
| 99172-CPT | Low | Ocular Function Screen, 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-CPT | Low | Visual Acuity Screen, Screening Test Of Visual Acuity Quantitative Bilateral Note: (The Screening Test Used Must Employ Graduated Visual Acuity Stimuli That Allow A Quantitative Estimate Of Visual Acuity (Eg Snellen Chart). Other Identifiable Services Unrelated To This Screening Test Provided At The Same Time May Be Reported Separately (Eg Preventive Medicine Services). When Acuity Is Measured As Part Of A General Ophthalmological Service Or Of An E/M Service Of The Eye It Is A Diagnostic Examination And Not A Screening Test.) |
| 99174-CPT | Low | Lazy Eye Screening Test, Screening Test For Amblyopia (Lazy Eye). Amblyopia Is A Problem With Visual Development In Which The Brain Favors One Eye Over The Other Causing The Visual Brain Cells In The Neglected Eye To Fail To Mature. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99173. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99173 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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