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See a sample rate comparisonCPT 99358 Fee Schedule
Last Verified: October 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.
Prolonged Evaluation And Management Service Beforeand/Or After Direct Patient Care; First Hour Eg Review Of Extensive Records And Tests Communication With Other Professionals And/Or The Patient/Family); First Hour (List Separately In Addition To Code(S) For Other Physician Service(S) And/Or Inpatient Or Outpatient Evaluation And Management Service)
| Key Fact | Detail |
|---|---|
| Service Type | Evaluation and Management Prolonged Services |
| Common Place of Service | 11 - Office 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital |
| Common Modifiers | GY - Notice of Liability Not Issued, Not Required Under Payer Policy. 95 - Telemedicine - audio and video |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 99358 |
| Medicaid Fee Schedule | $90.065 median of the 8 states in the free preview · View Medicaid rates for 99358 |
National average reimbursement for CPT 99358 by major payers:
$126.12
$131.19
$127.13
$157.63
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CPT 99358
5 of 25 sample ratesHigher to lower in this preview
Chase Parsons
Associated Physicians Of Harvard Faculty Physicians At Beth Isreal
$350.94Published rateAmanda Bowers
Marblehead Pediatrics Inc.
$214.33Published rateDenise Toshach
Family Health Network Of Central New York Inc
$121.61Published rateMaureen Mathews
North Shore Pediatrics, P.C.
$106.38Published rateMark Mazzare
Premium Choice Physicians
$55.50Published rate
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See a sample payer proposalCPT 99358 vs. Other Prolonged Services Codes
The CPT 99358 code is part of the Evaluation and Management services used for Prolonged Services. 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 99358 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 |
|---|---|---|
| 99215-CPT | High | Office O P Est Hi 40 Min, Office Or Other Outpatient Visit For The Evaluation And Management Of An Established Patient Which Requires A Medically Appropriate History And Or Examination And High Level Of Medical Decision Making When Using Total Time On The Date Of The Encounter For Code Selection 40 Minutes Must Be Met Or Exceeded |
| 99291-CPT | Moderate | Critical Care Evaluation And, Critical Care Evaluation And Management Of The Unstablecritically Ill Or Unstable Critically Injured Patient Requiring The Constant Attendance Of The Physician First |
| 99358-CPT | Low | Prolonged Evaluation And Management Service Beforeand/Or After Direct Patient Care; First Hour Eg Review Of Extensive Records And Tests Communication With Other Professionals And/Or The Patient/Family); First Hour (List Separately In Addition To Code(S) For Other Physician Service(S) And/Or Inpatient Or Outpatient Evaluation And Management Service) |
| 99359-CPT | Low | Prolonged Evaluation And Management Service Beforeand/Or After Direct Patient Care; Each Additional 30 Minutes (List Separately In Addition To Code For Prolonged Service) /Family); Each Additional 30 Minutes (List Separately In Addition To Code For Prolonged Physician Service) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99358. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99358 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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Frequently Asked Questions
The CPT 99358 code is part of the Evaluation and Management services used for Prolonged Services. 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 99358 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.