CPT 99195 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 • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • 59 - Distinct Procedural Service • PO - Services, procedures and/or surgeries furnished at off-campus provider-based outpatient departments |
| Complexity Level | Low |
National average reimbursement for CPT 99195 by major payers:
$118.32
$111.24
$121.88
$146.03
| 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 99195 | ||||||
United | 99195 | $82.29 | 1033128665 - AKRAM SHAKHASHIRO | 203918670 - (TX) SURE CARE HEALTH ASSOCIATES PA | TX | Internal Medicine Physician (207R00000X) |
United | 99195 | $150.44 | 1447287032 - GAGE VAN HORN | 384109786 - (TX) UT PHYSICIANS | TX | Neurology Physician (2084N0400X) |
United | 99195 | $93.40 | 1912998618 - HANH TRUONG | 760673289 | TX | Internal Medicine Physician (207R00000X) |
United | 99195 | $62.31 | 1154472017 - IRFAN LALANI | 261924416 - (TX) IRFAN LALANI MD PA | TX | Neurology Physician (2084N0400X) |
United | 99195 | $82.29 | 1104974955 - HAMEED ALI | 463854721 - (TX) COMPREHENSIVE INJURY TREATMENT SERVICES PLLC | TX | Internal Medicine Physician (207R00000X) |
United | 99195 | $165.60 | 1861836710 - BENJAMIN AERTKER | 273294332 - (TX) NEUROHOSPITALIST OF CLEAR LAKE PLLC | TX | Neurology Physician (2084N0400X) |
United | 99195 | $175.94 | 1942662770 - CHINTAN SHAH | 760386391 - KELSEY-SEYBOLD MEDICAL GROUP PLLC | TX | Neurology Physician (2084N0400X) |
United | 99195 | $108.00 | 1710161070 - SHAHNAZ BEGUM | 810727616 - (TX) TAKING HEALTH TO HEART PLLC | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99195 | $82.29 | 1992201537 - AUSTIN MEDICINE CONSULTANTS, PLLC | 824780841 - (TX) AUSTIN MEDICINE CONSULTANTS PLLC | TX | Internal Medicine Physician (207R00000X) |
United | 99195 | $91.19 | 1811069339 - WALTER BROGAN | 752651583 - (TX) CARDIOLOGISTS OF LUBBOCK, PA | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99195 | $27.79 | 1659422798 - DAVID FISH | 42888373 - BAYSTATE MEDICAL PRACTICES INC | MA | Pediatrics Physician (208000000X) |
United | 99195 | $159.25 | 1750342705 - BETH BROWN | 43202198 - (MA) WESTERN MASS PHYSICIAN ASSOCIATES INC | MA | Pediatrics Physician (208000000X) |
United | 99195 | $103.80 | 1063698967 - KARTHIKEYANI KATHIRESAN | 352526373 - ACCLAIM PHYSICIAN GROUP INC | TX | Neurology Physician (2084N0400X) |
United | 99195 | $206.63 | 1396197661 - CHAU NGUYEN | 742109824 - (TX) AUSTIN REGIONAL CLINIC PA | TX | Internal Medicine Physician (207R00000X) |
United | 99195 | $190.50 | 1851548622 - SUCHITRA KAMINENI | 822453465 - (TX) NORTH DALLAS PRIMARY CARE DOCTORS PLLC | 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 99195 vs. Other Other Medicine Services and Procedures Codes
The CPT 99195 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 99195 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 |
|---|---|---|
| 99070-CPT | Low | Supplies And Materials (Except Spectacles) Provided By The Physician Or Other Qualified Health Care Professional Over And Above Those Usually Included With The Office Visit Or Other Services Rendered (List Drugs Trays Supplies Ormaterials Provided) (Revised 01/01/13) |
| 99184-CPT | 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-CPT | Low | Application Of Topical Fluoride Varnish By A Physician Or Other Qualified Health Care Professional |
| 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 99195. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99195 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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