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See a sample rate comparisonCPT 99456 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.
Disability Examination, Work Related Or Medical Disability Examination By Other Than The Treating Physician That Includes Completion Of A Medical History Commensurate With The Patient S Condition Performance Of An Examination Commensurate With The Patient S Condition Formulation Of A Diagnosis Assessment Of Capabilities And Stability And Calculation Of Impairment Development Of Future Medical Treatment Plan And Completion Of Necessary Documentation Certificates And Report
| Key Fact | Detail |
|---|---|
| Service Type | Evaluation and Management Special Evaluation and Management Services |
| Common Place of Service | 11 - Office 20 - Urgent Care Facility |
| Common Modifiers | TS - Follow-up service |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 99456 |
| Medicaid Fee Schedule | $161.94 median of the 5 states in the free preview · View Medicaid rates for 99456 |
National average reimbursement for CPT 99456 by major payers:
$194.68
$147.84
$155.35
$303.74
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CPT 99456
5 of 25 sample ratesHigher to lower in this preview
Crosbyton Clinic Hospital
$1,272.00Published rateBrian Dearing
Cardiology Associates Of Mobile, Inc.
$80.55Published rateAll Ways Homecare Inc
$55.00Published rateDa Pediatric Rehabilitation
$40.00Published rateDa Pediatric Rehabilitation
$35.00Published rate
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See a sample payer proposalCPT 99456 vs. Other Special Evaluation and Management Services Codes
The CPT 99456 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 99456 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-CPT | Low | Basic Life Disability Exam, 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. |
| 99455-CPT | Low | Work Related Disability Exam, Work Related Or Medical Disability Examination By The Treating Physician That Includes Completion Of A Medical History Commensurate With The Patient S Condition Performance Of An Examination Commensurate With The Patient S Condition Formulation Of A Diagnosis Assessment Of Capabilities And Stability And Calculation Of Impairment Development Of Future Medical Treatment Plan And Completion Of Necessary Documentation Certificates And Report |
| 99456-CPT | Low | Disability Examination, Work Related Or Medical Disability Examination By Other Than The Treating Physician That Includes Completion Of A Medical History Commensurate With The Patient S Condition Performance Of An Examination Commensurate With The Patient S Condition Formulation Of A Diagnosis Assessment Of Capabilities And Stability And Calculation Of Impairment Development Of Future Medical Treatment Plan And Completion Of Necessary Documentation Certificates And Report |
| 99490-CPT | Low | Chrnc Care Mgmt Staff 1st 20, Chronic Care Management Services With The Following Required Elements Multiple Two Or More Chronic Conditions Expected To Last At Least 12 Months Or Until The Death Of The Patient Chronic Conditions That Place The Patient At Significant Risk Of Death Acute Exacerbation Decompensation Or Functional Decline Comprehensive Care Plan Established Implemented Revised Or Monitored First 20 Minutes Of Clinical Staff Time Directed By A Physician Or Other Qualified Health Care Professional Per Calendar Month |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99456. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99456 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
A CPT (Current Procedural Terminology) code is a medical code set used by physicians and other healthcare providers to report medical, surgical, and diagnostic procedures and services to entities such as health insurance companies and accreditation organizations. These codes standardize the way medical services are documented and billed.
To find the cost of a specific medical procedure, especially if you have a CPT code and your location, we recommend using Payerprice's fee schedule lookup tool. This tool allows users to search with a CPT code and specific location to get detailed pricing information. You can also contact your insurance provider for an estimate or the healthcare facility directly for their charges.
Medical costs can vary significantly due to several factors. These include the healthcare provider's geographic location, their specific fee schedules, the complexity of the procedure, whether the provider is in-network or out-of-network with your insurance, and the differing negotiated rates between various insurance companies and providers. Facility type (e.g., hospital vs. outpatient clinic) also plays a role.
If your medical bill seems too high, first, review it carefully for any errors and compare it against the Explanation of Benefits (EOB) from your insurance company. Contact the healthcare provider's billing department to discuss the bill, inquire about financial assistance programs, or set up a payment plan. You can also use tools like Payerprice to understand typical costs for the services you received in your area, which can be helpful information for negotiating a fair price.
No, insurance typically does not cover all medical procedures. Coverage depends heavily on your specific insurance plan's terms, whether the procedure is deemed medically necessary, if you've met your deductible, your co-pay and co-insurance requirements, and if the procedure is considered experimental or purely cosmetic. Always verify coverage with your insurance provider before undergoing any significant medical procedure to avoid unexpected costs.