What is CPT code 99368?

CPT code 99368 describes a medical team conference involving interdisciplinary healthcare professionals, without the patient or family present, lasting 30 minutes or more, with participation by a non-physician qualified healthcare professional. It is used to document and receive reimbursement for visits addressing moderate-level medical decision-making.

What factors affect fee schedules for CPT 99368?

Factors affecting fee schedules include Medicare & Medicaid rates (government-set reimbursement amounts), Private Insurance rates (negotiated between providers and insurance companies), Geographic Location (costs may be higher in urban areas), and Provider Type (hospital providers may have different rates than private practice).

Where can I find Medicare rates for CPT 99368?

You can view Medicare rates for CPT 99368 on the PayerPrice website, often via a dedicated Medicare fee schedule lookup tool, which provides government-set reimbursement amounts for the specified year.

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.

How do I find out the cost of a specific medical procedure or service?

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.

What is a fee schedule in healthcare?

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.

Where can I find healthcare fee schedules?

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.

How can I estimate what my out-of-pocket costs will be for a medical service?

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.

CPT 99368 Fee Schedule

Q: How does CPT 99368 compare to other case management codes?

The CPT 99368 code is part of Evaluation and Management services for Case Management. It represents a moderate-complexity encounter involving 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.

Last Verified: July 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	Medical Team Conference, Without Direct (Face-to-Face) Contact With Patient and/or Family Medical Team Conferences
Common Place of Service	11 - Office None
Common Modifiers	None HE GO - Services delivered under an outpatient occupational therapy plan of care
Complexity Level	Low
Medicare Fee Schedule	View Medicare rates for 99368

National average reimbursement for CPT 99368 by major payers:

$43.91

$44.72

$42.24

$64.44

Preview provider-level rates for...

For billing codeCPT 99368

Payer	Code	Rate	NPI	Tax ID	State	Specialty
United	99368	$38.09	1699332825 - EMBEE LIFESTYLE DOCS PLLC	824704903 - (TX) EMBEE LIFESTYLE DOCS PLLC	TX	Internal Medicine Physician (207R00000X)
United	99368	$49.72	1770683336 - JIMMIE APPEL	752743883 - (TX) COVENANT MEDICAL GROUP	TX	Internal Medicine Physician (207R00000X)
United	99368	$51.38	1710361506 - AREEB BANGASH	274433830 - (OK) MERCY HOSPITAL TISHOMINGO INC	TX	Internal Medicine Physician (207R00000X)
United	99368	$37.24	1124116132 - VISHU LAMMATA MD PA	752207970 - (TX) VISHU LAMMATA, M.D., P.A.	TX	Cardiovascular Disease Physician (207RC0000X)
United	99368	$49.77	1003133315 - ANAND PATEL	741613878 - (TX) BAYLOR COLLEGE OF MEDICINE	TX	Neurology Physician (2084N0400X)
United	99368	$51.16	1437598174 - CHRISTINA PALLADINO	232380812 - ST LUKES PHYSICIAN GROUP INC	MA	Pediatrics Physician (208000000X)
United	99368	$51.25	1164833810 - PAKPOOM TANTRACHOTI	452867352 - INTEGRIS CARDIOVASCULAR PHYSICIANS LLC	TX	Cardiovascular Disease Physician (207RC0000X)
United	99368	$35.50	1548257660 - LAWRENCE DEHNER	222592333 - SOUTHCOAST HOSPITALS GROUP INC	MA	Pediatrics Physician (208000000X)
United	99368	$50.49	1558328229 - HASHIM MOHMAND	752616977 - CHRISTUS TRINITY CLINIC	TX	Internal Medicine Physician (207R00000X)
United	99368	$123.62	1316233000 - FAROUK TALAKSHI	752613493 - TEXAS HEALTH PHYSICIANS GROUP	TX	Internal Medicine Physician (207R00000X)
United	99368	$49.77	1992148076 - ASHISH GUPTA	741613878 - (TX) BAYLOR COLLEGE OF MEDICINE	TX	Internal Medicine Physician (207R00000X)
United	99368	$95.69	1124214572 - ELIZABETH COUGHLIN	42730094 - (MA) WAREHAM PEDIATRIC ASSOCIATES, P.C.	MA	Pediatrics Physician (208000000X)
United	99368	$69.44	1790896355 - SARI MIETTINEN	43194547 - MASS GENERAL BRIGHAM INCORPORATED	MA	Pediatrics Physician (208000000X)
United	99368	$81.54	1730642828 - ANDREW ZHANG	760386391 - KELSEY-SEYBOLD MEDICAL GROUP PLLC	TX	Neurology Physician (2084N0400X)
United	99368	$60.75	1629005418 - RICHARD ARROYO-DIAZ	746003411	TX	Internal Medicine Physician (207R00000X)
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 99368 vs. Other Medical Team Conferences Codes

The CPT 99368 code is part of the Medical Team Conference, Without Direct (Face-to-Face) Contact With Patient and/or Family services used for Medical Team Conferences. 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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