CPT 99454 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 • GW - Condition not related to the patient's terminal condition • 95 - Telemedicine - audio and video |
| Complexity Level | Moderate |
National average reimbursement for CPT 99454 by major payers:
$68.30
$76.83
$64.98
$96.42
| 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 99454 | ||||||
United | 99454 | $91.04 | 1992905335 - PARAG MERAI | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 99454 | $120.41 | 1114196995 - ANGELA GREEN | 910844563 | LA | Psychiatry Physician (2084P0800X) |
United | 99454 | $72.84 | 1447413919 - GHOUSE MOHIUDDIN | 510457240 | IL | Psychiatry Physician (2084P0800X) |
United | 99454 | $131.67 | 1144203753 - HAIDAR KABBANI | 363279680 - (IL) PEDIATRIC FACULTY FOUNDATION IN | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 99454 | $112.76 | 1669598421 - CHANDRIKA SHANKAR | 911780160 | NY | Psychiatry Physician (2084P0800X) |
United | 99454 | $113.70 | 1245252303 - MARY FAHRMEIER | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IL | Psychiatry Physician (2084P0800X) |
United | 99454 | $62.29 | 1922111657 - CLINT ANTHONY | 860830701 | IL | Psychiatry Physician (2084P0800X) |
United | 99454 | $90.25 | 1073648192 - NIRANJAN KARNIK | 376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 99454 | $55.52 | 1144267865 - NITIN PATEL | 462706345 | MO | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 99454 | $96.27 | 1518124932 - RITU TALWAR | 363994258 - (IL) HORIZONS BEHAVIORAL HEALTH LLC | IL | Psychiatry Physician (2084P0800X) |
United | 99454 | $73.62 | 1023112745 - NELDA AKINBILE | 366006541 - (IL) VETERANS ASSISTANCE COMMISSION C | IL | Psychiatry Physician (2084P0800X) |
United | 99454 | $78.22 | 1497767719 - ELIZABETH CHARNEY | 376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 99454 | $115.72 | 1407807746 - SYED KHAN | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IL | Psychiatry Physician (2084P0800X) |
United | 99454 | $96.86 | 1568533701 - REGINALD GIVENS | 362222696 - SWEDISHAMERICAN HOSPITAL | IL | Psychiatry Physician (2084P0800X) |
United | 99454 | $91.94 | 1497198832 - GABRIEL FUQUA | 363149833 - NORTHWESTERN MEMORIAL HEALTHCARE | IL | Psychiatry Physician (2084P0800X) |
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 99454 vs. Other Special Evaluation and Management Services Codes
The CPT 99454 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 99454 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 | Low | 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. |
| 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 |
| 99453 | Low | Remote Monitoring Of Physiologic Parameter(S) (Eg, Weight, Blood Pressure, Pulse Oximetry, Respiratory Flow Rate), Initial; Set-Up And Patient Education On Use Of Equipment |
| 99454 | Low | Remote Monitoring Of Physiologic Parameter(S) (Eg Weight Blood Pressure Pulse Oximetry Respira- Tory Flow Rate) Initial; Device(S) Supply With Daily Recording(S) Or Programmed Alert(S) Transmission Each 30 Days |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99454. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99454 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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