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 | $417.02 | 1447464466 - NICOLE RANDAZZO-AHERN | 43466314 - MASS GENERAL BRIGHAM INCORPORATED | MA | Pediatrics Physician (208000000X) |
United | 99195 | $171.47 | 1952352510 - HENRY NTENDE | 261318597 - MERCY CLINIC FORT SMITH COMMUNITIES | TX | Internal Medicine Physician (207R00000X) |
United | 99195 | $158.28 | 1801875380 - JENNIFER GILL | 42472758 - (MA) CHILD HEALTH FOUNDATION OF BOSTON INC | MA | Pediatrics Physician (208000000X) |
United | 99195 | $69.73 | 1184692451 - LARA KOTHARI | 822784244 - (MI) BEAUMONT MEDICAL GROUP - SPECIALTY SERVICES | MA | Pediatrics Physician (208000000X) |
United | 99195 | $159.52 | 1205330545 - KINJAL GADHIYA | 823342633 - (TX) SYNERGY EMERGENCY CONSULTANTS PLLC | TX | Internal Medicine Physician (207R00000X) |
United | 99195 | $48.72 | 1538453295 - DAVID RUBIO | 760273984 | TX | Internal Medicine Physician (207R00000X) |
United | 99195 | $101.05 | 1912198102 - KIMBERLY VERNON | 300791563 | TX | Internal Medicine Physician (207R00000X) |
United | 99195 | $108.00 | 1710161070 - SHAHNAZ BEGUM | 810727616 - (TX) TAKING HEALTH TO HEART PLLC | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99195 | $82.29 | 1922016997 - QUAN LE | 260436172 | TX | Internal Medicine Physician (207R00000X) |
United | 99195 | $108.00 | 1407020035 - HOANG-ANH PHAN | 871142127 - (TX) LION STAR NACOGDOCHES HOSPITAL, LLC DBA NACOGDOCHES MEMORIAL HOSPITAL | TX | Internal Medicine Physician (207R00000X) |
United | 99195 | $134.22 | 1467491803 - JAMES ELDRIDGE | 752566987 | TX | Internal Medicine Physician (207R00000X) |
United | 99195 | $88.98 | 1932562253 - GOWANI HEALTHCARE ASSOCIATES INC | 272601863 - (TX) GOWANI HEALTHCARE ASSOCIATES INC | TX | Internal Medicine Physician (207R00000X) |
United | 99195 | $252.11 | 1184600348 - BRITTANNY BOULANGER | 43397450 - (MA) ATRIUS HEALTH, INC. | MA | Pediatrics Physician (208000000X) |
United | 99195 | $368.63 | 1669000196 - ALISON CASSERLY | 42911067 - UMASS MEMORIAL HEALTH CARE INC | MA | Pediatrics Physician (208000000X) |
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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