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See a sample rate comparisonCPT 99452 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 Rfrl, Interprofessional Telephone Internet Electronic Health Record Referral Service S Provided By A Treating Requesting Physician Or Other Qualified Health Care Professional 30 Minutes
| Key Fact | Detail |
|---|---|
| Service Type | Evaluation and Management Special Evaluation and Management Services |
| Common Place of Service | 11 - Office |
| Common Modifiers | 25 - Significant, separately identifiable E/M service same day 95 - Telemedicine - audio and video |
| Complexity Level | Low |
| Medicare Fee Schedule | $37.08 national non-facility rate (2026) · View Medicare rates for 99452 |
| Medicaid Fee Schedule | $29.59 median of the 8 states in the free preview · View Medicaid rates for 99452 |
National average reimbursement for CPT 99452 by major payers:
$45.29
$43.35
$38.87
$61.77
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CPT 99452
5 of 25 sample ratesHigher to lower in this preview
Peter Greenspan
Mass General Brigham Incorporated
$105.98Published rateAlbert Dalley
$49.33Published rateJoseph Kass
$43.15Published rateJamal Lone
Perioperative And Transitional
$31.89Published rateBanger-Hill & Associates
Bangerhill Associates
$26.54Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 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 |
|---|---|---|
| 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 |
| 99452-CPT | Low | Ntrprof Ph1 Ntrnet Ehr Rfrl, 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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