CPT 99437 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 • Care Management Services |
| Common Place of Service | • None • 11 - Office |
| 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 99437 by major payers:
$72.08
$78.48
$64.80
$106.30
| 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 99437 | ||||||
United | 99437 | $91.86 | 1992901334 - CHAFEN HART | 742044647 - NATIONAL JEWISH HEALTH | MA | Pediatrics Physician (208000000X) |
United | 99437 | $83.94 | 1689624488 - LAURI BALLARD | 752566987 | TX | Internal Medicine Physician (207R00000X) |
United | 99437 | $138.60 | 1033506191 - CHRISTOPHER IRWIN | 550638563 - UNITED PHYSICIANS CARE INC | TX | Internal Medicine Physician (207R00000X) |
United | 99437 | $57.40 | 1760837736 - LISE AGNANT MALEBRANCHE | 475300786 - (TX) INPATIENT PROGRESSIVE HEALTHCARE OF AMERICA | TX | Internal Medicine Physician (207R00000X) |
United | 99437 | $76.06 | 1174985634 - NUMAN JAHANGIR | 363358384 | TX | Internal Medicine Physician (207R00000X) |
United | 99437 | $74.33 | 1841295334 - RUPIN KADAKIA | 760613299 - (TX) HEART CARE CENTER OF NORTHWEST HOUSTON, P.A. | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99437 | $183.21 | 1437115672 - JO ELLEN ALTSCHAEFL | 43466314 - MASS GENERAL BRIGHAM INCORPORATED | MA | Pediatrics Physician (208000000X) |
United | 99437 | $130.66 | 1215012000 - MANISHA SHAH | 390808443 - ASPIRUS STEVENS POINT HOSPITAL & CLINICS INC | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99437 | $94.62 | 1437253093 - JUDI SHAW-RICE | 593140335 - BAYCARE MEDICAL GROUP INC | TX | Internal Medicine Physician (207R00000X) |
United | 99437 | $95.15 | 1982108908 - MEGHAN SWINEHART | 36013761 - (VT) NORTHEASTERN VERMONT REGIONAL HOSPITAL INC | MA | Pediatrics Physician (208000000X) |
United | 99437 | $87.06 | 1174190748 - HAMZA SALIM | 204923281 - MEMORIAL HERMANN MEDICAL GROUP | TX | Internal Medicine Physician (207R00000X) |
United | 99437 | $199.80 | 1982282125 - RYAN BREWSTER | 42103881 - BETH ISRAEL DEACONESS MEDICAL CENTER INC | MA | Pediatrics Physician (208000000X) |
United | 99437 | $59.79 | 1952741795 - LEON TIO | 820738699 - (TX) LEON S TIO MD PA | TX | Internal Medicine Physician (207R00000X) |
United | 99437 | $75.20 | 1902008196 - JESUS CASAS | 363305449 - (IL) MOUNT SINAI COMMUNITY FOUNDATION | TX | Internal Medicine Physician (207R00000X) |
United | 99437 | $99.65 | 1508215237 - SYEDA RAZA | 752536818 - HEALTHTEXAS PROVIDER NETWORK | 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 99437 vs. Other Care Management Services Codes
The CPT 99437 code is part of the Evaluation and Management services used for Care Management 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 99437 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) |
| 99437 | Low | Chronic Care Management Services With The Following Required Elements: Multiple (Two Or More) Chronic Conditions Expected To Last At Least 12 Months, Or Until The Death Of The Patient, Chronic Conditions That Place The Patient At Significant Risk Of Death, Acute Exacerbation/Decompensation, Or Functional Decline, Comprehensive Care Plan Established, Implemented, Revised, Or Monitored; Each Additional 30 Minutes By A Physician Or Other Qualified Health Care Professional, Per Calendar Month (List Separately In Addition To Code For Primary Procedure) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99437. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99437 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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