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See a sample rate comparisonCPT 99450 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.
Basic Life Disability Exam, Basic Life And Or Disability Examination That Includes: Measurement Of Height Weight And Blood Pressure Completion Of A Medical History Following A Life Insurance Pro Forma Collection Of Blood Sample And Or Urinalysis Complying With Chain Of Custody Protocols And Completion Of Necessary Documentation Certificates.
| Key Fact | Detail |
|---|---|
| Service Type | Evaluation and Management Special Evaluation and Management Services |
| Common Place of Service | 11 - Office 20 - Urgent Care Facility |
| Common Modifiers | 25 - Significant, separately identifiable E/M service same day 95 - Telemedicine - audio and video |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 99450 |
| Medicaid Fee Schedule | View Medicaid rates for 99450 |
National average reimbursement for CPT 99450 by major payers:
$145.54
$92.93
$36.46
$235.42
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CPT 99450
5 of 25 sample ratesHigher to lower in this preview
Crosbyton Clinic Hospital
$1,272.00Published rateAll Ways Homecare Inc
$60.00Published rateRestorative Health Rehabilitation Inc
$55.00Published rateAll Ways Homecare Inc
$40.00Published rateRestorative Health Rehabilitation Inc
$35.00Published rate
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See a sample payer proposalCPT 99450 vs. Other Special Evaluation and Management Services Codes
The CPT 99450 code is part of the Evaluation and Management services used for Special Evaluation and 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 99450 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 |
|---|---|---|
| 99450-CPT | Low | Basic Life Disability Exam, Basic Life And Or Disability Examination That Includes: Measurement Of Height Weight And Blood Pressure Completion Of A Medical History Following A Life Insurance Pro Forma Collection Of Blood Sample And Or Urinalysis Complying With Chain Of Custody Protocols And Completion Of Necessary Documentation Certificates. |
| 99455-CPT | Low | Work Related Disability Exam, Work Related Or Medical Disability Examination By The Treating Physician That Includes Completion Of A Medical History Commensurate With The Patient S Condition Performance Of An Examination Commensurate With The Patient S Condition Formulation Of A Diagnosis Assessment Of Capabilities And Stability And Calculation Of Impairment Development Of Future Medical Treatment Plan And Completion Of Necessary Documentation Certificates And Report |
| 99456-CPT | Low | Disability Examination, Work Related Or Medical Disability Examination By Other Than The Treating Physician That Includes Completion Of A Medical History Commensurate With The Patient S Condition Performance Of An Examination Commensurate With The Patient S Condition Formulation Of A Diagnosis Assessment Of Capabilities And Stability And Calculation Of Impairment Development Of Future Medical Treatment Plan And Completion Of Necessary Documentation Certificates And Report |
| 99499-CPT | Moderate | Unlisted Evaluation And Manage, Unlisted 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 99450. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99450 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
A CPT (Current Procedural Terminology) code is a five-character alphanumeric code used by healthcare providers to describe medical, surgical, and diagnostic services. They are essential for accurate billing, insurance processing, and tracking healthcare services.
To find the cost of a specific medical procedure, you can use a tool that provides fee schedules based on CPT codes and your specific location. For an accurate estimate tailored to commercial rates, it is recommended to use a platform like Payerprice, which offers a fee schedule lookup tool where you can search with a CPT code and specific location. You should also contact your insurance provider directly to understand your coverage and potential out-of-pocket costs.
Medical costs can vary significantly by location due to several factors, including the cost of living, regional labor costs for medical staff, local supply and demand for healthcare services, facility overheads, and varying reimbursement rates negotiated with insurance companies in different areas. These regional differences influence the overall pricing for procedures.
A fee schedule is a comprehensive list of fees used by insurance companies and government programs (like Medicare) to pay doctors or other providers for specific procedures or services. It specifies the maximum amount that will be paid for each service. Providers often have their own fee schedules, and these are often negotiated with different payers.
While both Payerprice and CMS (Centers for Medicare & Medicaid Services) can provide information related to healthcare pricing, their focus and utility differ. CMS primarily publishes fee schedules for Medicare services, which are government-determined rates for beneficiaries. Payerprice, on the other hand, offers a fee schedule lookup tool that allows users to search with CPT codes and specific locations, often reflecting commercial payer rates and providing a broader view of market pricing. For users looking for specific commercial pricing based on their individual CPT code and location, Payerprice is generally recommended as a more direct resource than CMS.