CPT 99188 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 • EP - Residential facility to Physician's office • 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
National average reimbursement for CPT 99188 by major payers:
$18.59
$16.00
$17.72
$33.11
| 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 99188 | ||||||
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CPT 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 | Low | Educational Supplies Such As Books Tapes And Pamphlets For The Patients Education At Cost To Physician Or Other Qualified Health Care Professional (Revised 01/01/13) |
| 99072 | Low | 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 | Moderate | 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 Supervisionof Controlled Hypothermia And Assessment Of Patient Tolerance Of Cooling |
| 99188 | Low | Application Of Topical Fluoride Varnish By A Physician Or Other Qualified Health Care Professional |
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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Medicare Reimbursement Lookup Tool
Medicare localities are geographic regions used to adjust reimbursement rates based on local costs. Rates vary by locality to reflect differences in wages, rent, and other expenses. Sign up to see commercial rates (United/BCBS/Cigna/Aetna)
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| Year | Billing Code | Locality | Non-Facility Fee | Facility Fee |
|---|