CPT 99191 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 | • 21 - Inpatient Hospital • 11 - Office • 22 - On Campus Outpatient Hospital • 23 - Emergency Room |
| Common Modifiers | • None • 76 - Repeat procedure by same physician • GC - Service performed by resident under supervision |
| Complexity Level | Moderate |
National average reimbursement for CPT 99191 by major payers:
$426.57
$411.28
$337.26
$584.58
| 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 99191 | ||||||
United | 99191 | $333.02 | 1588906986 - AMIT ALAM | 132655001 - NEW YORK CITY HEALTH AND HOSPITALS CORPORATION | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99191 | $246.57 | 1285641704 - RAUL MARTINEZ | 742080607 | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99191 | $277.39 | 1538203724 - RAMESHBHAI PATEL | 844888657 - (TX) EVEREST URGENT CARE MD PA | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99191 | $462.00 | 1134351950 - JON AVERY GO | 990258833 - (HI) CHARLIE Y. SONIDO, M.D., INC. | TX | Internal Medicine Physician (207R00000X) |
United | 99191 | $402.95 | 1376771915 - VINOOP DAGGUBATI | 271371893 | TX | Internal Medicine Physician (207R00000X) |
United | 99191 | $1194.31 | 1558345835 - ALICE NEWTON | 42807148 - MASS GENERAL BRIGHAM INCORPORATED | MA | Pediatrics Physician (208000000X) |
United | 99191 | $1844.68 | 1144488974 - JENISE WONG | 943281657 | MA | Pediatrics Physician (208000000X) |
United | 99191 | $277.39 | 1891931820 - TAIWO KUYE | 844006305 - (TX) TAIWO A KUYE MD PA | TX | Internal Medicine Physician (207R00000X) |
United | 99191 | $405.70 | 1780790717 - BHARATH POLA | 202148889 - (TX) HEALTHTEXAS MEDICAL GROUP | TX | Internal Medicine Physician (207R00000X) |
United | 99191 | $262.10 | 1720175797 - RAMA LAXMAN | 204857458 - THE INPATIENT SPECIALISTS, PA | TX | Internal Medicine Physician (207R00000X) |
United | 99191 | $1042.84 | 1629134697 - JUSTIN SWEDER | 475190965 - (MA) LEXINGTON PEDIATRICS, LLC | MA | Pediatrics Physician (208000000X) |
United | 99191 | $588.67 | 1811309362 - SHEREAN FARVARDIN | 752536818 - HEALTHTEXAS PROVIDER NETWORK | TX | Internal Medicine Physician (207R00000X) |
United | 99191 | $277.39 | 1033640909 - SAMREEN KHUWAJA | 934249326 - (TX) TEXAS PRIMARY CARE PLLC | TX | Internal Medicine Physician (207R00000X) |
United | 99191 | $398.08 | 1639175458 - JIM GUERRA | 421537461 | TX | Internal Medicine Physician (207R00000X) |
United | 99191 | $473.89 | 1013155050 - JAIME RUEDA | 741613878 - (TX) BAYLOR COLLEGE OF MEDICINE | 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 99191 vs. Other Other Medicine Services and Procedures Codes
The CPT 99191 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 99191 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 |
|---|---|---|
| 99190-CPT | Moderate | Assembly And Operation Of Pump With Oxygenator Or Heat Exchanger (With Or Without Ecg And/Or Pressure Monitoring); Each Hour |
| 99191-CPT | Moderate | Assembly And Operation Of Pump With Oxygenator Or Heat Exchanger (With Or Without Ecg And/Or Pressure Monitoring); 45 Minutes |
| 99192-CPT | Moderate | Assembly And Operation Of Pump With Oxygenator Or Heat Exchanger (With Or Without Ecg And/Or Pressure Monitoring); 30 Minutes |
| 99195-CPT | Low | Phlebotomy, Therapeutic |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99191. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99191 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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