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See a sample rate comparisonCPT 99188 Fee Schedule
Last Verified: October 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.
Fluoride Varnish Application, A Prescription Strength Fluoride Varnish Is Applied Directly To Teeth Considered To Be At A High Risk Of Damage From Decay. The Therapy Is Designed To Prevent Cavities.
| 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 | EP - Residential facility to Physician's office 59 - Distinct Procedural Service |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 99188 |
| Medicaid Fee Schedule | $13.33 median of the 8 states in the free preview · View Medicaid rates for 99188 |
National average reimbursement for CPT 99188 by major payers:
$18.59
$16.00
$17.72
$32.71
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CPT 99188
5 of 25 sample ratesHigher to lower in this preview
Kristin Sleeper
Pediatric Health Care Associates, P.C.
$41.16Published rateWhite Rock Adult Medicine Assoc PA
Drs. Hendler, Pizette, Comess, Hillert, Fitzharris & Haddox, P.A.
$18.89Published rateHagos Aymut
Mmh Physicians
$15.05Published rateZakari Kwota
Total Md Physicians Group PLLC
$11.36Published rateRodriguez Clinical Trials LLC, Rodriguez Medical Clinic At Bellaire
Rodriguez Clinical Trials LLC
$8.65Published rate
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See a sample payer proposalCPT 99188 vs. Other Other Medicine Services and Procedures Codes
The CPT 99188 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 99188 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 |
|---|---|---|
| 99071-CPT | Low | Patient Education Materials, Educational Supplies Such As Books Tapes And Pamphlets For The Patient S Education At Cost To Physician Or Other Qualified Health Care Professional |
| 99072-CPT | Low | Addl Supl Matrl Staf Tm Phe, Additional Supplies Materials And Clinical Staff Time Over And Above Those Usually Included In An Office Visit Or Other Non Facility Service S When Performed During A Public Health Emergency As Defined By Law Due To Respiratory Transmitted Infectious Disease |
| 99184-CPT | Moderate | Hypothermia Ill Neonate, Initiation Of Selective Head Or Total Body Hypothermia In The Critically Ill Neonate Includes Appropriate Patient Selection By Review Of Clinical Imaging And Laboratory Data Confirmation Of Esophageal Temperature Probe Location Evaluation Of Amplitude Eeg Supervision Of Controlled Hypothermia And Assessment Of Patient Tolerance Of Cooling |
| 99188-CPT | Low | Fluoride Varnish Application, A Prescription Strength Fluoride Varnish Is Applied Directly To Teeth Considered To Be At A High Risk Of Damage From Decay. The Therapy Is Designed To Prevent Cavities. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99188. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99188 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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