CPT 99375 Fee Schedule
Last Updated: April 2025
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
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 • Care Plan Oversight Services |
| Common Place of Service | • 11 - Office • 22 - On Campus-Outpatient Hospital • None |
| Common Modifiers | • None • GV - Attending physician is not employed or paid under agreement by the patient's Hospice provider • SA |
| Complexity Level | Moderate |
National average reimbursement for CPT 99375 by major payers:
$130.78
$131.35
$124.69
$163.08
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.
CPT 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.
| CPT Code | Complexity Level | 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 |
See what providers are getting paid in 2024 for 99375:
CPT 99375 Fee Schedule & Reimbursement Rates
The CPT 99375 fee schedule varies by payer type. Below are Medicare rates for 2024 and average in-network rates by state across major payers:
| Code | Medicare Rate | Avg. Cigna National Rate | More Info |
|---|---|---|---|
| 99367 | $53.26 | $93.97 | |
| 99368 | $34.62 | $64.36 | |
| 99374 | $67.91 | $107.89 | |
| 99375 | $100.86 | $163.08 | |
| 99377 | $67.91 | $107.88 | |
| 99379 | $67.91 | $107.80 |
Reimbursement rates depend on provider contracts, region, and payer. Always verify rates with your insurance provider or medical billing department.
What is price transparency?
The Price Transparency Rule is a federal law that took effect in July 2022, requiring all commercial payers to publicly disclose their prices through machine-readable files (MRFs). In short, this regulation mandates that insurance companies make healthcare costs transparent to the public.
Our data comes directly from these insurer-posted MRFs, ensuring compliance with the Price Transparency Rule. While PayerPrice is working toward a future where providers and payers collaborate for 100% upfront price certainty, it's important to acknowledge that data limitations and occasional errors may exist.
Healthcare Price Transparency Rule
cms.govConsumer Guide To Healthcare Prices
aha.orgGlossary of Healthcare Terms
healthcare.govUnlock access to price transparency insights today.
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