CPT 99452 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 |
| 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 99452 by major payers:
$45.29
$43.35
$38.87
$61.58
| 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 99452 | ||||||
United | 99452 | $56.15 | 1013910546 - M SHARIF | 752651583 - (TX) CARDIOLOGISTS OF LUBBOCK, PA | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99452 | $30.15 | 1487034039 - GREGORY DUHON | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | TX | Internal Medicine Physician (207R00000X) |
United | 99452 | $39.52 | 1316988215 - ANNA HARKINS | 202798379 - (TX) CLEAR LAKE SPECIALTIES, PA | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99452 | $28.07 | 1912121831 - PENELOPE GONZALEZ MD PA | 43840469 - (TX) PENELOPE GONZALEZ MD PA | TX | Internal Medicine Physician (207R00000X) |
United | 99452 | $46.79 | 1184458838 - HOSPITALIST MEDICINE PHYSICIANS OF TEXAS | 824535639 | TX | Internal Medicine Physician (207R00000X) |
United | 99452 | $94.12 | 1588602320 - KRISTIN LYNCH | 42817581 - (MA) NORTHAMPTON AREA PEDIATRICS, LLP | MA | Pediatrics Physician (208000000X) |
United | 99452 | $94.12 | 1548791023 - CASEY FEIN | 42817581 - (MA) NORTHAMPTON AREA PEDIATRICS, LLP | MA | Pediatrics Physician (208000000X) |
United | 99452 | $94.12 | 1740215888 - ALISON MARTIN | 42468387 - (MA) WOBURN PEDIATRIC ASSOCIATES | MA | Pediatrics Physician (208000000X) |
United | 99452 | $45.61 | 1255548251 - MOUNT AUBURN HOSPITAL | 42103606 - (MA) MOUNT AUBURN HOSPITAL | MA | Pediatrics Physician (208000000X) |
United | 99452 | $48.22 | 1376179655 - HAYDEN SPRINGER | 646010232 - (MS) GULFPORT SURGERY CLINIC, LLC | TX | Internal Medicine Physician (207R00000X) |
United | 99452 | $94.12 | 1730143264 - AMY RYAN | 42460242 - LONGWOOD PEDIATRICS, LLP | MA | Pediatrics Physician (208000000X) |
United | 99452 | $105.98 | 1316934581 - JOCELYN JOSEPH | 42697983 - MASS GENERAL BRIGHAM INCORPORATED | MA | Pediatrics Physician (208000000X) |
United | 99452 | $77.01 | 1558476168 - CYNTHIA DE MEESTER | 390808443 - ASPIRUS STEVENS POINT HOSPITAL & CLINICS INC | MA | Pediatrics Physician (208000000X) |
United | 99452 | $83.66 | 1992785125 - KIMBERLY TRESCH | 43397450 - (MA) ATRIUS HEALTH, INC. | MA | Pediatrics Physician (208000000X) |
United | 99452 | $115.58 | 1013478882 - JEFFREY WALBRIDGE | 320058309 - ASSOCIATED PHYSICIANS OF HARVARD FACULTY PHYSICIANS AT BETH ISREAL | MA | Pediatrics Physician (208000000X) |
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 99452 vs. Other Special Evaluation and Management Services Codes
The CPT 99452 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 99452 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 |
|---|---|---|
| 99446 | 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;5-10 Minutes Of Medical Consultative Discussion And Review (Desc Rvsd 1/1/23) |
| 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) |
| 99452 | Low | Interprofessional Telephone/Internet/Electronic Health Record Referral Service(S) Provided By A Treating/Requesting Physician Or Other Qualified Health Care Professional 30 Minutes |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99452. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99452 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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