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See a sample rate comparisonCPT 99195 Fee Schedule
Last Verified: September 2026
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.
Phlebotomy, Therapeutic
| 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 |
| Medicare Fee Schedule | View Medicare rates for 99195 |
| Medicaid Fee Schedule | View Medicaid rates for 99195 |
National average reimbursement for CPT 99195 by major payers:
$118.32
$111.24
$121.88
$144.81
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CPT 99195
5 of 25 sample ratesHigher to lower in this preview
Nicole Randazzo-Ahern
Mass General Brigham Incorporated
$417.02Published rateHenry Ntende
Mercy Clinic Fort Smith Communities
$171.47Published rateSaleem Akbar
Cardiovascular Physicians Of North Texas
$116.12Published rateAkram Shakhashiro
Sure Care Health Associates PA
$82.29Published rateDavid Rubio
$48.72Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 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 | Special Supplies Phys Qhp, 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 Or Materials Provided |
| 99184-CPT | Moderate | Hypothermia Ill Neonate, 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 Supervision Of Controlled Hypothermia And Assessment Of Patient Tolerance Of Cooling |
| 99188-CPT | Low | Fluoride Varnish Application, A Prescription Strength Fluoride Varnish Is Applied Directly To Teeth Considered To Be At A High Risk Of Damage From Decay. The Therapy Is Designed To Prevent Cavities. |
| 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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