CPT 99360 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 | • Evaluation and Management • Prolonged Services |
| Common Place of Service | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital • 11 - Office |
| Common Modifiers | • None • 25 - Significant, separately identifiable E/M service same day • 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
National average reimbursement for CPT 99360 by major payers:
$80.15
$73.45
$71.97
$95.91
| 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 99360 | ||||||
United | 99360 | $56.84 | 1114051091 - RIO GRANDE MEDICINE, INC | 742620023 - (TX) RIO GRANDE MEDICINE INC | TX | Internal Medicine Physician (207R00000X) |
United | 99360 | $85.76 | 1063601110 - ALEXANDER VENIZELOS | 341790929 - SUMMA HEALTH | TX | Neurology Physician (2084N0400X) |
United | 99360 | $81.43 | 1720616279 - KULJOT BANSI | 271371893 | TX | Internal Medicine Physician (207R00000X) |
United | 99360 | $135.89 | 1760495105 - PORTER PEDIATRICS COMPREHENSIVE PEDIATRIC HEALTH CARE.PC | 203602910 - (MA) PORTER PEDIATRICS COMPREHENSIVE PEDIATRIC HEALTH CARE, PC | MA | Pediatrics Physician (208000000X) |
United | 99360 | $65.47 | 1245437425 - JOSE BURGOS | 843432779 - (TX) MOBILEMED PLLC | TX | Internal Medicine Physician (207R00000X) |
United | 99360 | $50.52 | 1164495339 - IMRAN NATHANI | 760619845 - (TX) IMRAN NATHANI, M.D., P.A. | TX | Internal Medicine Physician (207R00000X) |
United | 99360 | $69.48 | 1205883774 - VINIT MEHROTRA | 272634334 - (TX) TARRANT NEUROLOGY CONSULTANTS PA | TX | Neurology Physician (2084N0400X) |
United | 99360 | $123.13 | 1629423330 - JESSICA WILLIS | 300554775 - (NC) MOSES CONE AFFILIATED PHYSICIANS INC | TX | Internal Medicine Physician (207R00000X) |
United | 99360 | $102.41 | 1699209106 - BRIAN CONWAY | 272996872 - (TX) CARDIOLOGY SPECIALISTS OF NORTH TEXAS PLLC | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99360 | $83.37 | 1255321980 - SHERIF ISKANDER | 465720165 - (TX) ALIGNED PROVIDERS OF EAST TEXAS | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99360 | $65.44 | 1457585739 - OLAYIWOLA SALMON | 621545731 - BAPTIST MEMORIAL MEDICAL GROUP INC | TX | Internal Medicine Physician (207R00000X) |
United | 99360 | $108.63 | 1992023188 - TIMOTHY GONG | 911947573 | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99360 | $50.04 | 1992759849 - SUNG LIM | 204701276 | TX | Internal Medicine Physician (207R00000X) |
United | 99360 | $120.63 | 1497190698 - RIHAM JAMALEDDINE | 752536818 - HEALTHTEXAS PROVIDER NETWORK | TX | Internal Medicine Physician (207R00000X) |
United | 99360 | $133.39 | 1699209106 - BRIAN CONWAY | 141338544 - SAMARITAN HOSPITAL | TX | Cardiovascular Disease Physician (207RC0000X) |
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 99360 vs. Other Prolonged Services Codes
The CPT 99360 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 99360 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 |
|---|---|---|
| 99221 | Low | Initial Hospital Inpatient Or Observation Care Per Day For The Evaluation And Management Of A Patient Which Requires A Medically Appropriate History And/Or Examination And Straightforward Or Low Level Medical Decision Making. When Using Total Time On The Date Of The Encounter For Code Selection 40 Minutes Must Be Met Or Exceeded. (Desc Rvsd 1/1/23) |
| 99222 | Moderate | Initial Hospital Inpatient Or Observation Care Per Day For The Evaluation And Management Of A Patient Which Requires A Medically Appropriate History And/Or Examination And Moderate Level Of Medical Decision Making. When Using Total Time On The Date Of The Encounter For Code Selection 55 Minutes Must Be Met Or Exceeded. (Desc Rvsd 1/1/23) |
| 99223 | High | Initial Hospital Inpatient Or Observation Care Per Day For The Evaluation And Management Of A 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 75 Minutes Must Be Met Or Exceeded. (Desc Rvsd 1/1/23) |
| 99360 | Low | Standby Service Requiring Prolonged Attendance Each 30 Minutes (Eg Operative Standby Standby For Frozen Section For Cesarean/High Risk Delivery For Monitoring Eeg) (Revised 01/01/13) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99360. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99360 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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