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See a sample rate comparisonCPT 99451 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.
Ntrprof Ph1 Ntrnet Ehr 5, Interprofessional Telephone Internet Electronic Health Record Assessment And Management Service Provided By A Consultative Physician Or Other Qualified Health Care Professional Including A Written Report To The Patient S Treating Requesting Physician Or Other Qualified Health Care Professional 5 Minutes Or More Of Medical Consultative Time
| Key Fact | Detail |
|---|---|
| Service Type | Evaluation and Management Special Evaluation and Management Services |
| Common Place of Service | 11 - Office 22 - On Campus Outpatient Hospital |
| Common Modifiers | GQ - Alaska and Hawaii only - asynchronous telecommunication system 95 - Telemedicine - audio and video |
| Complexity Level | Low |
| Medicare Fee Schedule | $35.41 national non-facility rate (2026) · View Medicare rates for 99451 |
| Medicaid Fee Schedule | $29.42 median of the 8 states in the free preview · View Medicaid rates for 99451 |
National average reimbursement for CPT 99451 by major payers:
$46.22
$43.62
$40.87
$63.03
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CPT 99451
5 of 25 sample ratesHigher to lower in this preview
Lisa Forrester
$176.00Published rateSanober Khan
Adult Inpatient Medical Services
$49.56Published rateVitor Pacheco
Access Telecare PLLC
$39.65Published rateMariana Gonzalez Del Hierro
Md Hospitalists PLLC
$36.50Published ratePriyank Dhar
Corpus Christi Hospitalists PLLC
$30.02Published rate
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See a sample payer proposalCPT 99451 vs. Other Special Evaluation and Management Services Codes
The CPT 99451 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 99451 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 |
|---|---|---|
| 99447-CPT | Low | Ntrprof Ph1 Ntrnet Ehr 11 20, Interprofessional Telephone Internet Electronic Health Record Assessment And Management Service Provided By A Consultative Physician Or Other Qualified Health Care Professional Including A Verbal And Written Report To The Patient S Treating Requesting Physician Or Other Qualified Health Care Professional 11 20 Minutes Of Medical Consultative Discussion And Review |
| 99448-CPT | Low | Ntrprof Ph1 Ntrnet Ehr 21 30, Interprofessional Telephone Internet Electronic Health Record Assessment And Management Service Provided By A Consultative Physician Or Other Qualified Health Care Professional Including A Verbal And Written Report To The Patient S Treating Requesting Physician Or Other Qualified Health Care Professional 21 30 Minutes Of Medical Consultative Discussion And Review |
| 99449-CPT | Low | Ntrprof Ph1 Ntrnet Ehr 31, Interprofessional Telephone Internet Electronic Health Record Assessment And Management Service Provided By A Consultative Physician Or Other Qualified Health Care Professional Including A Verbal And Written Report To The Patient S Treating Requesting Physician Or Other Qualified Health Care Professional 31 Minutes Or More Of Medical Consultative Discussion And Review |
| 99451-CPT | Low | Ntrprof Ph1 Ntrnet Ehr 5, Interprofessional Telephone Internet Electronic Health Record Assessment And Management Service Provided By A Consultative Physician Or Other Qualified Health Care Professional Including A Written Report To The Patient S Treating Requesting Physician Or Other Qualified Health Care Professional 5 Minutes Or More Of Medical Consultative Time |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99451. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99451 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
You can start by contacting your healthcare provider's billing department and your insurance company for an estimate. For more specific, localized pricing information based on particular procedure codes (CPT codes), you can use specialized tools. We recommend utilizing Payerprice's fee schedule lookup tool, which allows you to search with a CPT code and your specific location.
CPT (Current Procedural Terminology) codes are standardized alphanumeric codes used by medical professionals and facilities to describe medical, surgical, and diagnostic services. Knowing the CPT code for your procedure is critical because it allows you to accurately search for and compare prices for the exact service across different providers and locations. Tools like Payerprice use CPT codes to provide specific fee schedule information.
For specific pricing information tailored to a CPT code and your geographic location, Payerprice offers a dedicated fee schedule lookup tool. This platform enables users to search for prices, providing valuable insights to help you understand potential costs before receiving care. You can use your CPT code and location to get relevant pricing data.
Looking up healthcare prices before receiving care empowers you to make informed decisions about your healthcare. It allows you to compare costs between different providers, choose more affordable options for 'shoppable' services, and potentially save a significant amount of money. Price transparency helps you avoid surprise bills and budget for medical expenses more effectively.
While a single, universal database covering every provider and payer doesn't exist, resources like Payerprice provide comprehensive tools for comparing costs. Payerprice offers a fee schedule lookup tool where you can search with a CPT code and specific location to access pricing insights, helping you compare potential costs from various payers and providers in your area.