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See a sample rate comparisonCPT 99418 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.
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)
| Key Fact | Detail |
|---|---|
| Service Type | Evaluation and Management Preventive Medicine Services |
| Common Place of Service | 21 - Inpatient Hospital 99 - Other POS 22 - On Campus Outpatient Hospital |
| Common Modifiers | 25 - Significant, separately identifiable E/M service same day FS - Split/shared E/M visit |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 99418 |
| Medicaid Fee Schedule | $28.19 median of the 8 states in the free preview · View Medicaid rates for 99418 |
National average reimbursement for CPT 99418 by major payers:
$50.94
$45.79
$46.62
$72.85
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CPT 99418
5 of 25 sample ratesHigher to lower in this preview
Rodrigo Zepeda
$103.48Published rateMarium Butt
Methodist Hospital
$63.25Published rateFonda Chan
Neurology Consultants Of Dallas, P.A.
$51.43Published rateMy Le
Bich Van Nguyen, M.D., P.A.
$38.27Published rateOmnihealth Physicians Group
$31.31Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 99418 vs. Other Preventive Medicine Services Codes
The CPT 99418 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 99418 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 99418. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99418 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
To find out the cost of a medical procedure before you get it, you can contact your insurance company for an estimate based on your specific plan benefits and deductible status. You can also directly ask your healthcare provider for a good faith estimate. For a more detailed lookup of prices based on CPT codes and your specific location, Payerprice offers a fee schedule lookup tool that can provide relevant cost information.
CPT stands for Current Procedural Terminology. CPT codes are standardized five-character alphanumeric codes used to describe medical, surgical, and diagnostic services and procedures. They are crucial in medical billing because they identify the specific services rendered, which in turn determines how healthcare providers are reimbursed by insurance companies and what patients are charged. Each CPT code has an associated fee that can vary widely by provider, insurance plan, and geographic location.
Fee schedules for medical services are typically proprietary to insurance companies and individual healthcare providers. While hospitals are required to publish chargemasters, these often reflect list prices that are rarely paid by patients or insurers. For a more specific and actionable fee schedule based on CPT codes and your location, Payerprice offers a lookup tool that can help you understand the prevailing rates.
Medical costs can vary significantly between providers due to a multitude of factors, including geographic location, the provider's reputation and specialization, the facility type (e.g., hospital vs. independent clinic), negotiated rates with different insurance companies, operational costs, and the specific services included in a procedure. There is no single, standardized price for most medical services.
A chargemaster price is the list price for a medical service or item, set by a hospital or healthcare provider. It is essentially the starting point for billing. However, the actual paid price is usually much lower. This is because insurance companies negotiate discounted rates with providers, and uninsured patients may also be eligible for discounts or financial assistance. The chargemaster price rarely reflects what an individual patient or insurer actually pays.
Yes, in many cases, you can negotiate medical bills. If you are uninsured or have a high deductible, contacting the provider's billing department is often a good first step. You can ask for a discount, set up a payment plan, or inquire about financial assistance programs. Comparing prices beforehand using tools like Payerprice can also give you leverage in negotiations.