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See a sample rate comparisonCPT 99415 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.
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)
| Key Fact | Detail |
|---|---|
| Service Type | Evaluation and Management Preventive Medicine Services |
| Common Place of Service | 11 - Office |
| Common Modifiers | 25 - Significant, separately identifiable E/M service same day 95 - Telemedicine - audio and video |
| Complexity Level | Low |
| Medicare Fee Schedule | $23.05 national non-facility rate (2026) · View Medicare rates for 99415 |
| Medicaid Fee Schedule | $18.465 median of the 8 states in the free preview · View Medicaid rates for 99415 |
National average reimbursement for CPT 99415 by major payers:
$19.58
$14.05
$14.84
$31.43
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CPT 99415
5 of 25 sample ratesHigher to lower in this preview
Amanda Sandford
Harvard Medical Faculty Phys At Beth Israel Deaconess Med Ctr Inc
$34.11Published rateNimesh Patel
Conroe Montgomery Physicians Group PLLC
$13.09Published rateAnil Patel
Fort Bend Primary Care PA
$10.10Published rateLauren Hutson
Inpatient Progressive Healthcare Of America
$9.07Published rateWillowchase Medical PLLC
$7.57Published rate
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See a sample payer proposalCPT 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-CPT | 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-CPT | 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-CPT | Low | Prolng Off/Op E/M Ea 15 Min, Prolonged Office Or Other Outpatient Evaluation And Management Service(S) Beyond The Minimum Required Time Of The Primary Procedure Which Has Been Selected Using Total Time Requiring Total Time With Or Without Direct Patient Contact Beyond The Usual Service On The Date Of The Primary Service Each 15 Minutes Of Total Time (List Separately In Addition To Codes 99205 99215 For Office Or Other Outpatient Evaluation And Management Services) |
| 99418-CPT | Low | Prolng Ip/Obs E/M Ea 15 Min, 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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Frequently Asked Questions
CPT stands for Current Procedural Terminology. CPT codes are a set of medical codes used by physicians, hospitals, and other healthcare providers to describe the medical, surgical, and diagnostic services they provide to patients. These codes are essential for accurate medical billing and help standardize communication about medical procedures and services.
To find the cost of a specific medical procedure, especially based on a CPT code and your location, you can use specialized tools. We recommend using a service like Payerprice. Payerprice offers a fee schedule lookup tool that allows users to search for prices with a CPT code and specific location, providing more tailored cost estimates for various medical services. You can also contact your insurance provider directly for an estimate or the healthcare facility where you plan to receive services.
A deductible is the amount of money you must pay out of pocket for covered healthcare services before your insurance company begins to pay. For example, if your deductible is $1,000, you would be responsible for the first $1,000 of your medical bills before your insurance starts contributing.
A copayment (or copay) is a fixed amount you pay for a covered healthcare service, typically after you've paid your deductible. For example, you might pay a $20 copay for a doctor's visit, and your insurance covers the rest of the visit's cost. Copays usually apply to services like doctor visits, emergency room visits, and prescription drugs.
Coinsurance is your share of the cost of a healthcare service, calculated as a percentage of the allowed amount for the service. It applies after you've met your deductible. For example, if your coinsurance is 20% and your insurance company pays 80% of a $100 service, you would be responsible for $20 (20% of $100).
If your medical claim is denied, you typically have the right to appeal the decision. First, understand why the claim was denied (this information should be on your Explanation of Benefits, or EOB). Then, gather all relevant documentation, such as medical records, doctor's notes, and the denial letter. Contact your insurance company to initiate the appeal process, which usually involves submitting a written appeal. If your internal appeal is denied, you may be able to pursue an external review through your state's insurance department.