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See a sample rate comparisonCPT 99199 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.
Special Service Or Report, A Service Procedure Or Report That Is Above And Beyond The Usual For A Condition.
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Other Medicine Services and Procedures |
| Common Place of Service | 81 - Independent Laboratory 11 - Office |
| Common Modifiers | None U5 GP - Services delivered under an outpatient physical therapy plan of care |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 99199 |
National average reimbursement for CPT 99199 by major payers:
$675.29
$66.09
$3,365.70
$90.66
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CPT 99199
5 of 25 sample ratesHigher to lower in this preview
Emory University, Emory University Hospital
Emory University
$77.06Published rateThe Medical Center Of Central Georgia Inc.
Medical Center Of Central Georgia Inc
$58.31Published rateLatania Booker
Straub Clinic & Hospital
$44.40Published rateAll Ways Homecare Inc
$40.00Published rateBrian Dearing
Cardiology Associates Of Mobile, Inc.
$8.80Published rate
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See a sample payer proposalCPT 99199 vs. Other Other Medicine Services and Procedures Codes
The CPT 99199 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 99199 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 |
|---|---|---|
| 99075-CPT | Low | Testimony For A Legal Case, Testimony By A Health Care Professional About Medical Care That Is Provided To A Medical Board In A Deposition Or As A Witness In A Court Case. |
| 99082-CPT | Low | Unusual Travel (Eg Transport & Escort Of Patient), Unusual Travel (Eg Transportation And Escort Of Patient) |
| 99190-CPT | Moderate | Assembly And Operation Of Pump, Assembly And Operation Of Pump With Oxygenator Or Heatexchanger (With Or Without Ecg Andor Pressuremonitoring) Each Hour |
| 99199-CPT | Moderate | Special Service Or Report, A Service Procedure Or Report That Is Above And Beyond The Usual For A Condition. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99199. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99199 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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