CPT 99451 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 • Special Evaluation and Management Services |
| Common Place of Service | • 11 - Office • None • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • GQ - Alaska and Hawaii only - asynchronous telecommunication system • 95 - Telemedicine - audio and video |
| Complexity Level | Moderate |
National average reimbursement for CPT 99451 by major payers:
$46.22
$43.62
$40.87
$62.38
| 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 99451 | ||||||
United | 99451 | $42.83 | 1184667545 - ANDREW FITZGERALD | 752434817 - (TX) M.D. ON CALL, P.A. | TX | Internal Medicine Physician (207R00000X) |
United | 99451 | $35.65 | 1982869293 - MAHWISH ILYAS | 61491820 - (CT) MASONICARE PRIMARY CARE PHYSICIANS | TX | Internal Medicine Physician (207R00000X) |
United | 99451 | $31.64 | 1134150857 - JANA DECKER | 901017049 - (TX) VOHRA POST ACUTE CARE PHYSICIANS OF TEXAS PLLC | TX | Internal Medicine Physician (207R00000X) |
United | 99451 | $33.00 | 1013065382 - MOHAMAD NAWAR | 132655001 - NEW YORK CITY HEALTH AND HOSPITALS CORPORATION | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99451 | $37.25 | 1922263565 - STONEBRIDGE ADULT MEDICINE PA | 262905960 - (TX) STONEBRIDGE ADULT MED | TX | Internal Medicine Physician (207R00000X) |
United | 99451 | $39.40 | 1497014369 - TEXAS PHYSICIANS GROUP | 455232942 - (TX) TEXAS PHYSICIANS GROUP | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99451 | $60.79 | 1457581498 - SVJETLANA MIOCINOVIC | 582030692 - EMORY UNIVERSITY | TX | Neurology Physician (2084N0400X) |
United | 99451 | $71.68 | 1306017983 - MARIAM RAZI | 752536818 - HEALTHTEXAS PROVIDER NETWORK | TX | Internal Medicine Physician (207R00000X) |
United | 99451 | $37.52 | 1043420524 - MARIA TERESA RUBIO-PINAROC | 223875077 - (TX) TERESA R PINAROC MD PA | TX | Internal Medicine Physician (207R00000X) |
United | 99451 | $30.02 | 1720630825 - YALAMANCHILI PHYSICIANS GROUP PLLC | 842230438 - (TX) YALAMANCHILI PHYSICIANS GROUP PLLC | TX | Internal Medicine Physician (207R00000X) |
United | 99451 | $81.13 | 1679860290 - KINJAL DESAI | 273818647 | TX | Neurology Physician (2084N0400X) |
United | 99451 | $35.97 | 1235274994 - JOHN ROSSI | 560845796 - CUMBERLAND COUNTY HOSPITAL SYSTEM INC | TX | Neurology Physician (2084N0400X) |
United | 99451 | $39.40 | 1750152294 - NAUTILUS MEDICAL GROUP | 934459545 - (TX) NAUTILUS MEDICAL GROUP | TX | Internal Medicine Physician (207R00000X) |
United | 99451 | $30.90 | 1578753265 - JOHN BADLISSI | 263175240 - (TX) JOHN K BADLISSI MD PA | TX | Internal Medicine Physician (207R00000X) |
United | 99451 | $28.14 | 1295784247 - VICTORIA MEDICAL & REHABILITATION ASSOCIATES, P.A. | 742895467 - (TX) VICTORIA MEDICAL REHABILITATION ASSOCIATES PA | 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 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 | Low | 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 Patients Treating/Requesting Physician Or Other Qualified Health Care Professional;11-20 Minutes Of Medical Consultative Discussion And Review (Desc Rvsd 1/1/23) |
| 99448 | Low | 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 Patients Treating/Requesting Physician Or Other Qualified Health Care Professional;21-30 Minutes Of Medical Consultative Discussion And Review (Desc Rvsd 1/1/23) |
| 99449 | Low | 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 Patients Treating/Requesting Physician Or Other Qualified Health Care Professional;31 Minutes Or More Of Medical Consultative Discussion And Review (Desc Rvsd 1/1/23) |
| 99451 | Low | 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 Patients Treating/Requesting Physician Or Other Qualified Health Care Professional 5 Minutes Or More Of Medical Consultative Time (Desc Rvsd 1/1/23) |
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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