CPT 99358 Fee Schedule

Last Verified: January 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	• None • GY - Notice of Liability Not Issued, Not Required Under Payer Policy. • 95 - Telemedicine - audio and video
Complexity Level	Low

National average reimbursement for CPT 99358 by major payers:

$126.12

$131.19

$127.13

$158.32

Preview provider-level rates for...

For billing codeCPT 99358

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 99358
United	99358	$121.61	1013087998 - DENISE TOSHACH	161133983 - (NY) FAMILY HEALTH NETWORK OF CENTRAL NEW YORK INC	MA	Pediatrics Physician (208000000X)
United	99358	$119.36	1104974955 - HAMEED ALI	844413195 - (TX) BACK IN MOTION INTEGRATED MEDICINE PLLC	TX	Internal Medicine Physician (207R00000X)
United	99358	$137.05	1649361577 - CHRYSTAL WITTCOPP	42888373 - BAYSTATE MEDICAL PRACTICES INC	MA	Pediatrics Physician (208000000X)
United	99358	$307.95	1609213750 - LEELA SARATHY	222560501 - (MA) MASS GENERAL BRIGHAM INCORPORATED	MA	Pediatrics Physician (208000000X)
United	99358	$55.50	1891769709 - MARK MAZZARE	833128365 - (TX) PREMIUM CHOICE PHYSICIANS	TX	Internal Medicine Physician (207R00000X)
United	99358	$171.77	1346738903 - JOANNA CHANG	300520570 - (TX) METHODIST HOSPITAL	TX	Neurology Physician (2084N0400X)
United	99358	$214.33	1568824902 - AMANDA BOWERS	42702637 - (MA) MARBLEHEAD PEDIATRICS INC.	MA	Pediatrics Physician (208000000X)
United	99358	$147.88	1669675757 - ANJANA PHILIP	271371893	TX	Internal Medicine Physician (207R00000X)
United	99358	$350.94	1609140490 - CHASE PARSONS	320058309 - ASSOCIATED PHYSICIANS OF HARVARD FACULTY PHYSICIANS AT BETH ISREAL	MA	Pediatrics Physician (208000000X)
United	99358	$90.94	1336147941 - SARA WESTGATE	742942926 - SARA WESTGATE, M.D., P.A.	TX	Neurology Physician (2084N0400X)
United	99358	$162.80	1851740567 - TREVOR CLARKSON	621490616 - BLUE RIDGE MEDICAL MANAGEMENT CORPORATION	TX	Internal Medicine Physician (207R00000X)
United	99358	$90.94	1750646717 - ELIZABETH ULLIMAN	271595277 - (TX) TEXAS IPS LLC	TX	Internal Medicine Physician (207R00000X)
United	99358	$120.70	1225087794 - AMARILLO VAMC	751616212	TX	General Acute Care Hospital (282N00000X)
United	99358	$112.22	1346661857 - JOANNA KINGSLEY TAVAREZ	752867667 - (TX) INPATIENT PHYSICIAN ASSOCIATES	TX	Internal Medicine Physician (207R00000X)
United	99358	$223.69	1073502985 - CHU CHEN	42484572 - (MA) MERRIMACK VALLEY PEDIATRIC ASSOCIATES, 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

Want to see your competitors' rates?

Start your trial today to unlock complete access to provider rates and fee schedules in your area.

Run a free sample report

Here's what you can do with PayerPrice

Renegotiate your managed care contracts

Benchmark your current rates against market averages to identify opportunities for rate optimization.

Prospect for new business using fee schedules

Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.

Integrate real-time payer data into your workflows

Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.

Explore state-level rates for free

PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.

CPT 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 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 Mintues Must Be Met Or Exceeded. (Desc Rvsd 1/1/2024)
99291-CPT	Moderate	Citical Care, Evaluation And Management Of The Unstable Critically Ill Or Unstable Critically Injured Patient, Requiring The Constant Attendance Of The Physician; Ist Hour
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.

FREE SAMPLE MARKET COMPARISON

Let's review your payer contracts side-by-side with the market.

Bring your top codes (like CPT 99358) and we'll show you how you compare in 15 minutes or less.

Schedule a Demo