CPT 99415 Fee Schedule

Last Verified: January 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 • None
Common Modifiers	• None • 25 - Significant, separately identifiable E/M service same day • 95 - Telemedicine - audio and video
Complexity Level	Low

National average reimbursement for CPT 99415 by major payers:

$19.58

$14.05

$14.84

$32.56

Preview provider-level rates for...

For billing codeCPT 99415

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	$8.09	1235132747 - JAMES VOSBERG	454129119 - (TX) SPURS LANE MEDICAL ASSOCIATES PA	TX	Internal Medicine Physician (207R00000X)
United	99415	$9.60	1538656186 - HPN PHYSICIAN BILLING, LLC	815158335	TX	Internal Medicine Physician (207R00000X)
United	99415	$20.31	1962445346 - ROBERT KELLER	465743396 - (TX) FORT WORTH MEDICAL SPECIALISTS PLLC	TX	Internal Medicine Physician (207R00000X)
United	99415	$21.60	1700204203 - MAUREEN HANDOKO-YANG	911352172 - MULTICARE HEALTH SYSTEM	TX	Neurology Physician (2084N0400X)
United	99415	$7.65	1043485212 - CATHIA MENDEZ-VARGAS	237087608 - (TX) PEOPLES COMMUNITY CLINIC INC	TX	Internal Medicine Physician (207R00000X)
United	99415	$13.25	1073784484 - VITTAL CHUNDRU	731388879	TX	Internal Medicine Physician (207R00000X)
United	99415	$11.68	1043571029 - MOHAMMAD MOJADIDI	263428410	TX	Cardiovascular Disease Physician (207RC0000X)
United	99415	$9.07	1245762327 - LAUREN HUTSON	475300786 - (TX) INPATIENT PROGRESSIVE HEALTHCARE OF AMERICA	TX	Internal Medicine Physician (207R00000X)
United	99415	$10.92	1821126525 - SAUD KHAN	756003935	TX	Neurology Physician (2084N0400X)
United	99415	$9.68	1356308381 - ADEBOLA OLATUNJI	208266938 - (TX) FORT WORTH INTERNAL MEDICINE, PA	TX	Internal Medicine Physician (207R00000X)
United	99415	$8.56	1164476602 - JULES PEAN	863432724 - (CA) MUNOZ FAMILY CARE INC	TX	Cardiovascular Disease Physician (207RC0000X)
United	99415	$32.68	1841496262 - REKHA ALEXANDER	752613493 - TEXAS HEALTH PHYSICIANS GROUP	TX	Internal Medicine Physician (207R00000X)
United	99415	$9.10	1053846196 - AIZAZ HUNDAL	853804440 - (TX) TRANSITIONAL CARE PHYSICIANS PLLC	TX	Neurology Physician (2084N0400X)
United	99415	$10.72	1356638886 - KATELYN LOPORTO	953777340 - CHILDRENS HOSPITAL LOS ANGELES MEDICAL GROUP INC	MA	Pediatrics Physician (208000000X)
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	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-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	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-CPT	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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