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See a sample rate comparisonCPT 99368 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 O Pat By Hc Pro, 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
| Key Fact | Detail |
|---|---|
| Service Type | Evaluation and Management Case Management Services |
| Common Place of Service | 11 - Office |
| Common Modifiers | HE GO - Services delivered under an outpatient occupational therapy plan of care |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 99368 |
| Medicaid Fee Schedule | $24.79 median of the 7 states in the free preview · View Medicaid rates for 99368 |
National average reimbursement for CPT 99368 by major payers:
$43.91
$44.72
$42.24
$64.44
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CPT 99368
5 of 25 sample ratesHigher to lower in this preview
Farouk Talakshi
Texas Health Physicians Group
$123.62Published rateAndrew Zhang
Kelsey-Seybold Medical Group PLLC
$81.54Published rateAreeb Bangash
Mercy Hospital Tishomingo Inc
$51.38Published rateAshish Gupta
Baylor College Of Medicine
$49.77Published rateLawrence Dehner
Southcoast Hospitals Group Inc
$35.50Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 99368 vs. Other Case Management Services Codes
The CPT 99368 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 99368 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-CPT | Low | Team Conf W O Pat By Phys, Medical Team Conference With Interdisciplinary Team Of Health Care Professionals Patient And Or Family Not Present 30 Minutes Or More Participation By Physician |
| 99368-CPT | Low | Team Conf W O Pat By Hc Pro, 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-CPT | Low | Home Health Care Supervision, Supervision Of A Patient Under Care Of Home Health Agency Patient Not Present In Home Domiciliary Or Equivalent Environment Eg Alzheimer S 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 Purposes Of Assessment Or Care Decisions With Health Care Professional S Family Member S Surrogate Decision Maker S Eg Legal Guardian And Or Key Caregiver S Involved In Patient S Care Integration Of New Information Into The Medical Treatment Plan And Or Adjustment Of Medical Therapy Within A Calendar Month 15 29 Minutes |
| 99375-CPT | Low | Home Health Care Supervision, Supervision Of A Patient Under Care Of Home Health Agency Patient Not Present In Home Domiciliary Or Equivalent Environment Eg Alzheimer S 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 Purposes Of Assessment Or Care Decisions With Health Care Professional S Family Member S Surrogate Decision Maker S Eg Legal Guardian And Or Key Caregiver S Involved In Patient S Care Integration Of New Information Into The Medical Treatment Plan And Or Adjustment Of Medical Therapy Within A Calendar Month 30 Minutes Or More |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99368. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99368 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 medical codes used by physicians, healthcare providers, and payers to describe medical, surgical, and diagnostic services. They are crucial for consistent communication among healthcare professionals and for billing purposes. Each CPT code represents a specific service or procedure, allowing for standardized documentation and processing of claims.
To find out the cost of a specific medical procedure or service, you will typically need the CPT code for that service. With the CPT code and your specific location, you can often search for estimated costs. For detailed and specific fee schedule information tailored to your location and the CPT code, you can use a dedicated tool. We recommend checking Payerprice, which offers a fee schedule lookup tool where you can search with a CPT code and specific location to get relevant pricing information.
A fee schedule in healthcare is a comprehensive listing of fees used by health insurance plans and government programs (like Medicare and Medicaid) to pay providers and suppliers. It outlines the maximum allowable amount that a payer will reimburse for each specific medical procedure or service, identified by its CPT code. These schedules vary significantly based on the payer, location, and type of service.
Healthcare fee schedules are typically proprietary information held by insurance companies and government payers. While some general information might be publicly available, finding precise, up-to-date fee schedules for specific CPT codes and locations can be challenging. For a convenient way to look up fee schedules based on a CPT code and your specific location, we recommend using a specialized tool like Payerprice. Their platform is designed to help users find this information.
Estimating your out-of-pocket costs involves several factors, including the service's CPT code, your insurance plan's deductible, co-insurance, and copayments, and whether the provider is in-network. First, obtain the CPT code for the service from your provider. Then, you can use a tool like Payerprice to look up potential fee schedule information for that CPT code in your location. After getting an idea of the service cost, contact your insurance provider to understand how your specific plan benefits (deductible, co-insurance, out-of-pocket maximums) apply to that service, especially noting if the provider is in-network or out-of-network. This combined approach will give you the most accurate estimate.