CPT 99175 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 • 21 - Inpatient Hospital • 50 - Federally Qualified Health Center • 20 - Urgent Care Facility |
| Common Modifiers | • None • 59 - Distinct Procedural Service • SL • EP - Residential facility to Physician's office • GC - Service performed by resident under supervision |
| Complexity Level | Moderate |
National average reimbursement for CPT 99175 by major payers:
$39.38
$34.94
$32.71
$47.35
| 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 99175 | ||||||
United | 99175 | $25.50 | 1306918933 - YARA FERNANDEZ | 260474768 - (MA) ABINGTON PEDIATRICS | MA | Pediatrics Physician (208000000X) |
United | 99175 | $28.81 | 1164933958 - MEDICAL CLINIC AT THE RANCH PLLC | 811710318 - (TX) MEDICAL CLINIC AT THE RANCH PLLC | TX | Internal Medicine Physician (207R00000X) |
United | 99175 | $40.77 | 1659304673 - EDIE SHULMAN | 742958277 - SCOTT & WHITE CLINIC | TX | Internal Medicine Physician (207R00000X) |
United | 99175 | $15.15 | 1043515166 - PEDRO J. PENALO, M.D., PLLC | 331175818 - (TX) PEDRO J. PENALO M.D., P.A. | TX | Internal Medicine Physician (207R00000X) |
United | 99175 | $48.25 | 1073700126 - SALIMA ABDUL WAHEED | 752536818 - HEALTHTEXAS PROVIDER NETWORK | TX | Internal Medicine Physician (207R00000X) |
United | 99175 | $27.79 | 1457387995 - SARITHA POTHULURI | 882742018 - SWING CARE PROVIDER GROUP PC | TX | Internal Medicine Physician (207R00000X) |
United | 99175 | $89.55 | 1447275128 - MARY TIMMINS-FINNELL | 43496971 - (MA) EAST MILTON PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | 99175 | $30.86 | 1114189081 - JACOB MANDEL | 300791563 | TX | Neurology Physician (2084N0400X) |
United | 99175 | $39.02 | 1679578777 - MARC CHAPMAN | 920813243 - (TX) CATALYST PHYSICIAN GROUP | TX | Internal Medicine Physician (207R00000X) |
United | 99175 | $34.15 | 1114994621 - CHARLES EWOH | 271371893 | TX | Internal Medicine Physician (207R00000X) |
United | 99175 | $22.72 | 1124423751 - DUC VU | 934374845 - (TX) DUC VU PLLC | TX | Internal Medicine Physician (207R00000X) |
United | 99175 | $41.70 | 1831208073 - HELEN LIM | 273834256 - (TX) WACO FUNCTIONAL MEDICINE PA | TX | Internal Medicine Physician (207R00000X) |
United | 99175 | $17.19 | 1124445259 - FARHAN ABDULLAH | 752966610 - (TX) PHYSICIAN ASSOCIATES OF SOUTHWEST DALLAS | TX | Internal Medicine Physician (207R00000X) |
United | 99175 | $14.27 | 1316919228 - MANUEL MERCADO | 680501547 - (TX) MANUEL J MERCADO MD PA | TX | Internal Medicine Physician (207R00000X) |
United | 99175 | $36.86 | 1619998838 - MONZER YAZJI | 752472510 | 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 99175 vs. Other Other Medicine Services and Procedures Codes
The CPT 99175 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 99175 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) |
| 99174 | Low | Instrument-Based Ocular Screening (Eg Photoscreening Automated-Refraction) Bilateral; With Remote Analysis And Report (Revised 01/01/2016) |
| 99175 | Low | Ipecac Or Similar Administration For Individual Emesis And Continued Observation Until Stomach Adequately Emptied Of Poison |
| 99177 | Low | Instrument-Based Ocular Screening (Eg, Photoscreening, Automated-Refraction) Bilateral; With On Site Analysis |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99175. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99175 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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