CPT 99367 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 • Case Management Services |
| Common Place of Service | • 11 - Office • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • SA • 25 - Significant, separately identifiable E/M service same day |
| Complexity Level | Moderate |
National average reimbursement for CPT 99367 by major payers:
$82.38
$68.41
$63.17
$93.97
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
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CPT 99367 vs. Other Case Management Services Codes
The CPT 99367 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 99367 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 |
|---|---|---|
| 99367 | Low | Medical Team Conference With Interdisciplinary Team Of Health Care Professionals Patient And/Or Family Not Present 30 Minutes Or More; Participation By Physician |
| 99368 | Low | Medical Team Conference With Interdisciplinary Team Of Health Care Professionals Patient And/Or Family Not Present 30 Minutes Or More; Participation By Nonphysician Qualified Health Care Professional |
| 99374 | Low | Supervision Of A Patient Under Care Of Home Healthagency (Patient Not Present) In Home Domiciliary Or Equivalent Environment (Eg Alzheimers Facility) Requiring Complex And Multidisciplinary Care Modalities Involving Regular Development And/Or Revision Of Care Plans By That Individual Review Of Subsequent Reports Of Patient Status Review Of Related Laboratory And Other Studies Communication (Including Telephone Calls) For Of Assessment Or Care Decisions (Revised |
| 99375 | Low | Supervision Of A Patient Under Care Of Home Healthagency (Patient Not Present) In Home Domiciliary Or Equivalent Environment (Eg Alzheimers Requiring Complex And Multidisciplinary Care Modalities Involving Regular Development And/Or Revision Of Care Plans By That Individual Review Subsequent Reports Of Patient Status Review Of Related Laboratory And Other Studies Communication (Including Telephone Calls) For Purposes Of Assessment (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 99367. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99367 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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Medicare Reimbursement Lookup Tool
Medicare localities are geographic regions used to adjust reimbursement rates based on local costs. Rates vary by locality to reflect differences in wages, rent, and other expenses. Sign up to see commercial rates (United/BCBS/Cigna/Aetna)
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| Year | Billing Code | Locality | Non-Facility Fee | Facility Fee |
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