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See a sample rate comparisonCPT 99375 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.
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
| Key Fact | Detail |
|---|---|
| Service Type | Evaluation and Management Care Plan Oversight Services |
| Common Place of Service | 11 - Office 22 - On Campus Outpatient Hospital |
| Common Modifiers | GV - Attending physician is not employed or paid under agreement by the patient's Hospice provider SA |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 99375 |
| Medicaid Fee Schedule | $93.42 median of the 8 states in the free preview · View Medicaid rates for 99375 |
National average reimbursement for CPT 99375 by major payers:
$130.78
$131.24
$124.69
$140.37
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CPT 99375
5 of 25 sample ratesHigher to lower in this preview
Nandini Sengupta
Dimock Community Foundation Inc Group Return
$333.32Published rateRim Alkawas
$264.08Published rateRobert Smitherman
Texas Health Physicians Group
$204.52Published rateMadhu Pamganamamula
Odessa Sleep Associates
$114.58Published rateSalman Bandeali
Cardiology Associates PA
$73.05Published rate
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See a sample payer proposalCPT 99375 vs. Other Care Plan Oversight Services Codes
The CPT 99375 code is part of the Evaluation and Management services used for Care Plan Oversight 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 99375 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 |
|---|---|---|
| 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 |
| 99377-CPT | Low | Hospice Care Supervision, Supervision Of A Hospice Patient Patient Not Present 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 |
| 99379-CPT | Low | Nursing Fac Care Supervision, Supervision Of A Nursing Facility Patient Patient Not Present 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 |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99375. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99375 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
The CPT 99375 code is part of the Evaluation and Management services used for Care Plan Oversight 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 99375 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.