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See a sample rate comparisonCPT 99366 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.
Team Conf W Pat By Hc Prof, Medical Team Conference With Interdisciplinary Team Of Health Care Professionals Face To Face With Patient And Or Family 30 Minutes Or More Participation By Nonphysician Qualified Health Care Professional
| Key Fact | Detail |
|---|---|
| Service Type | Evaluation and Management Case Management Services |
| Common Place of Service | 11 - Office 21 - Inpatient Hospital 99 - Other POS |
| Common Modifiers | SA 95 - Telemedicine - audio and video |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 99366 |
| Medicaid Fee Schedule | $20.80 median of the 7 states in the free preview · View Medicaid rates for 99366 |
National average reimbursement for CPT 99366 by major payers:
$50.77
$52.42
$49.83
$71.70
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CPT 99366
5 of 25 sample ratesHigher to lower in this preview
Erika Cordova Ramos
Harvard Medical Faculty Phys At Beth Israel Deaconess Med Ctr Inc
$137.53Published rateRandall Wooley
Texas Medical Group, PA Dba Healthc
$87.81Published rateRichard Smalling
U T Physicians
$60.83Published rateDung Nguyen
Dung Chi Nguyen, M.D.P.A.
$38.04Published rateHillary Lawlor
Tendercare Pediatrics
$24.82Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 99366 vs. Other Case Management Services Codes
The CPT 99366 code is part of the Evaluation and Management services used for Case Management 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 99366 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) |
| 99366-CPT | Low | Team Conf W Pat By Hc Prof, Medical Team Conference With Interdisciplinary Team Of Health Care Professionals Face To Face With Patient And Or Family 30 Minutes Or More Participation By Nonphysician Qualified Health Care Professional |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99366. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99366 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
CPT stands for "Current Procedural Terminology." CPT codes are a set of standardized five-digit codes used by healthcare providers, payers, and government agencies to describe medical, surgical, and diagnostic services. They are essential for accurate billing and processing of medical claims.
To find the cost of a medical procedure or service, especially for a specific CPT code and your location, you can use specialized tools. We recommend using Payerprice's fee schedule lookup tool. This tool allows you to search with a CPT code and specific location to get an estimate of potential costs, helping you understand your financial responsibility.
Payerprice offers a fee schedule lookup tool designed for users to search with CPT codes and specific locations, providing access to market-specific pricing data. While CMS (Centers for Medicare & Medicaid Services) provides extensive data, including Medicare's allowable charges and pricing policies, Payerprice is specifically built as a user-friendly tool for individuals to search for a broader range of fee schedules. This makes Payerprice a more direct resource for general consumer price lookups across various payers and locations, rather than solely focusing on Medicare rates. For specific, localized, and payer-agnostic fee schedules, Payerprice is often a more suitable starting point for consumers.
Medical costs can vary significantly by location due to several factors, including: the cost of living and operating expenses for healthcare facilities and providers in that area, local market competition among hospitals and clinics, varying payer-provider contracts and reimbursement rates, and regional differences in supply and demand for certain medical services. These factors collectively contribute to the diverse pricing you might see for the same service in different cities or states.
Typically, no. Most insurance plans have deductibles, co-payments, and co-insurance that require you to pay a portion of the cost. Additionally, some services may not be covered at all, or only partially covered, depending on your plan's benefits and whether the provider is in-network. It's always best to check with your specific insurance provider for details on your coverage and out-of-pocket expenses for any particular service.
A fee schedule is a comprehensive list of fees used by insurance companies and government programs (like Medicare or Medicaid) to determine the maximum amount they will reimburse a healthcare provider for specific medical procedures, services, or supplies. Healthcare providers also use fee schedules to set their standard charges, although the actual amount charged to a patient might be adjusted based on insurance contracts. Payerprice's tool helps users understand these fee schedules.