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See a sample rate comparisonCPT 99360 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.
Physician On-Call 30 Minutes, A Physician Remains Available In The Event That His Or Her Services Are Required. Examples May Include Standing By For Surgery Cesarean Section (C-Section) High Risk Delivery Or For Monitoring An Eeg (Brain Scan).
| 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 | Low |
| Medicare Fee Schedule | View Medicare rates for 99360 |
| Medicaid Fee Schedule | View Medicaid rates for 99360 |
National average reimbursement for CPT 99360 by major payers:
$80.15
$73.45
$71.97
$95.95
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CPT 99360
5 of 25 sample ratesHigher to lower in this preview
Lauren Steele
Mass General Brigham Incorporated
$177.89Published rateJaveria Naveed
Healthtexas Provider Network
$120.63Published rateHillary Lawlor
Bcd Health Partners, LLC
$78.40Published rateNeighborhood Adult Healthcare. PA
Neighborhood Adult Healthcare PA
$63.15Published rateHouston Hospicare PLLC
$46.97Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 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-CPT | Low | 1st Hosp Ip Obs Sf Low 40, 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 |
| 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) |
| 99360-CPT | Low | Physician On-Call 30 Minutes, A Physician Remains Available In The Event That His Or Her Services Are Required. Examples May Include Standing By For Surgery Cesarean Section (C-Section) High Risk Delivery Or For Monitoring An Eeg (Brain Scan). |
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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