CPT 99415 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 • Preventive Medicine Services |
| Common Place of Service | • 11 - Office • None |
| Common Modifiers | • None • 25 - Significant, separately identifiable E/M service same day • 95 - Telemedicine - audio and video |
| Complexity Level | Moderate |
National average reimbursement for CPT 99415 by major payers:
$19.58
$14.05
$14.84
$32.56
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 99415 | ||||||
United | 99415 | $14.61 | 1669443115 - SHERI BOYD | 852408381 - (TX) LONE STAR HEART AND VASCULAR CLINIC, P.A. | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99415 | $8.09 | 1235132747 - JAMES VOSBERG | 454129119 - (TX) SPURS LANE MEDICAL ASSOCIATES PA | TX | Internal Medicine Physician (207R00000X) |
United | 99415 | $17.13 | 1528473493 - EL PASO PRIMARY CARE PLLC | 260860059 - (TX) EL PASO PRIMARY CARE PLLC | TX | Internal Medicine Physician (207R00000X) |
United | 99415 | $9.10 | 1851325799 - EMMA CID | 822018496 - (TX) ANDRES VASQUEZ M.D., P.L.L.C. DBA ANDES HEART AND VASCULAR CENTER | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99415 | $8.59 | 1922468933 - TEXAS PHYSICIAN ASSOCIATES PLLC | 811397984 - (TX) TEXAS PHYSICIAN ASSOCIATES PLLC | TX | Internal Medicine Physician (207R00000X) |
United | 99415 | $32.68 | 1932197621 - ROBERT KLEINHAUS | 752613493 - TEXAS HEALTH PHYSICIANS GROUP | TX | Internal Medicine Physician (207R00000X) |
United | 99415 | $13.75 | 1396852158 - INTERNAL MEDICINE ASSOCIATES OF SUGAR LAND, INTERNAL MEDICINE ASSOCIATES OF SUGAR LAND | 760288045 - (TX) INTERNAL MEDICINE ASSOCIATES O | TX | Internal Medicine Physician (207R00000X) |
United | 99415 | $8.77 | 1568049757 - NICHOLAS MENZIONE | 815197762 - (TX) XPERT MD, PLLC | TX | Internal Medicine Physician (207R00000X) |
United | 99415 | $12.10 | 1427198373 - HONEY CHERUIYOT | 208536345 - (TX) PRMC HEALTHCARE GROUP INC | TX | Internal Medicine Physician (207R00000X) |
United | 99415 | $10.73 | 1366489908 - SARAH FERGUSON | 752660403 - (TX) HENDRICK PROVIDER NETWORK | TX | Internal Medicine Physician (207R00000X) |
United | 99415 | $20.31 | 1639154966 - RANDALL WOOLEY | 208866890 - (TX) TEXAS MEDICAL GROUP, PA DBA HEALTHC | TX | Internal Medicine Physician (207R00000X) |
United | 99415 | $13.09 | 1740228915 - NIMESH PATEL | 611684739 - (TX) CONROE MONTGOMERY PHYSICIANS GROUP PLLC | TX | Internal Medicine Physician (207R00000X) |
United | 99415 | $10.76 | 1932307253 - VIVIAN PUGH | 746000203 | TX | Internal Medicine Physician (207R00000X) |
United | 99415 | $7.57 | 1295291367 - DIVERSE COMMUNITY HEALTHCARE PLLC | 831763716 - (TX) DIVERSE COMMUNITY HEALTHCARE PLLC | TX | Internal Medicine Physician (207R00000X) |
United | 99415 | $8.57 | 1154406437 - | 262427082 - (TX) SAN ANTONIO PREMIER INTERNAL MEDICINE, PLLC | 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 99415 vs. Other Preventive Medicine Services Codes
The CPT 99415 code is part of the Evaluation and Management services used for Preventive Medicine 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 99415 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 |
|---|---|---|
| 99415 | Low | Prolonged Clinical Staff Service (The Service Beyond The Highest Time In The Range Of Total Timeof The Service) During An Evaluation And Management Service In The Office Or Outpatient Setting Direct Patient Contact With Physician Supervision; First Hour (List Separately In Addition To Code For Outpatient Evaluation And Management Service) (Desc Rvsd 1/1/21) |
| 99416 | Low | Prolonged Clinical Staff Service (The Service Beyond The Highest Time In The Range Of Total Timeof The Service) During An Evaluation And Management Service In The Office Or Outpatient Setting Direct Patient Contact With Physician Supervision; Each Additional 30 Minutes (List Separately In Addition To Code For Prolonged Service) (Desc Rvsd 1/1/21) |
| 99417 | Low | Prolonged Outpatient Evaluation And Management Service(S) Time With Or Without Direct Patient Contact Beyond The Required Time Of The Primary Service When The Primary Service Level Has Been Selected Using Total Time Each 15 Minutes Of Total Time (List Separately In Addition To The Code Of The Outpatient Evaluation And Management Service) (Desc Rvsd 1/1/23) For Office Or Other Outpatient Evaluation And Management Services) |
| 99418 | Low | Prolonged Inpatient Or Observation Evaluation And Management Service(S) Time With Or Without Direct Patient Contact Beyond The Required Time Of The Primary Service When The Primary Service Level Has Been Selected Using Total Time, Each 15 Minutes Of Total Time (List Separately In Addition To The Code Of The Inpatient And Observation Evaluation And Management Service) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99415. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99415 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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