CPT 99192 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 • 23 - Emergency Room • 11 - Office • 22 - On Campus Outpatient Hospital • 19 - Off Campus Outpatient Hospital |
| Common Modifiers | • None • 25 - Significant, separately identifiable E/M service same day • 59 - Distinct Procedural Service • 76 - Repeat procedure by same physician |
| Complexity Level | Moderate |
National average reimbursement for CPT 99192 by major payers:
$305.36
$292.15
$243.13
$417.07
| 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 99192 | ||||||
United | 99192 | $176.41 | 1700872439 - ROBERT BORREGO | 1700872439 - (TX) ROBERT BORREGO | TX | Internal Medicine Physician (207R00000X) |
United | 99192 | $351.04 | 1437492451 - WEI HE | 300520570 - (TX) METHODIST HOSPITAL | TX | Neurology Physician (2084N0400X) |
United | 99192 | $200.96 | 1982881124 - YATIN PATIL | 233026230 - (PA) MERCER BUCKS MEDICAL ASSOCIATES | TX | Internal Medicine Physician (207R00000X) |
United | 99192 | $237.72 | 1427021955 - PAUL MUELLER | 550853118 - CENTRAL TEXAS COMMUNITY HEALTH CENTERS | TX | Internal Medicine Physician (207R00000X) |
United | 99192 | $351.04 | 1245424415 - ALIAKBAR ARVANDI | 752668014 | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99192 | $198.46 | 1942221148 - CAROLINE MBOGUA | 852363125 - (TX) HOUSTON FAMILY MEDICINE PEDIATRICS PLLC | TX | Internal Medicine Physician (207R00000X) |
United | 99192 | $516.46 | 1720517303 - IAN HOPEWOOD | 43397450 - (MA) ATRIUS HEALTH, INC. | MA | Pediatrics Physician (208000000X) |
United | 99192 | $726.53 | 1073969523 - VICTOR LAMI | 582540964 | TX | Neurology Physician (2084N0400X) |
United | 99192 | $842.02 | 1861014250 - STEPHEN VORENBERG | 42103881 - BETH ISRAEL DEACONESS MEDICAL CENTER INC | MA | Pediatrics Physician (208000000X) |
United | 99192 | $424.80 | 1124196621 - ELIZABETH O'CONNOR | 237425849 - (MA) EAST BOSTON NEIGHBORHOOD HEALTH CENTER CORP | MA | Pediatrics Physician (208000000X) |
United | 99192 | $728.57 | 1073711768 - JAMELAH TUCKER | 590634433 - THE NEMOURS FOUNDATION | MA | Pediatrics Physician (208000000X) |
United | 99192 | $608.71 | 1346273646 - RONALD SUNOG | 43400617 - TUFTS MEDICAL CENTER PARENT INC | MA | Pediatrics Physician (208000000X) |
United | 99192 | $778.34 | 1467800268 - MADELEINE ELIA | 471370520 | MA | Pediatrics Physician (208000000X) |
United | 99192 | $289.80 | 1750659082 - SARAH GARDNER | 752566987 | TX | Internal Medicine Physician (207R00000X) |
United | 99192 | $199.64 | 1821282658 - CYPRESS CARDIOLOGY, P.A., THOMAS L DEBAUCHE MD | 263668341 - (TX) CYPRESS CARDIOLOGY PA | TX | Cardiovascular Disease Physician (207RC0000X) |
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 99192 vs. Other Other Medicine Services and Procedures Codes
The CPT 99192 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 99192 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 99192. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99192 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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