CPT 99457 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 | Work Related or Medical Disability Evaluation Services Special Evaluation and Management Services |
| Common Place of Service | 11 - Office None 99 - Other POS |
| Common Modifiers | None 95 - Telemedicine - audio and video GW - Condition not related to the patient's terminal condition |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 99457 |
National average reimbursement for CPT 99457 by major payers:
$57.62
$63.27
$57.19
$83.90
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 99457 | $85.80 | 1689673972 - TAMARAH FRATIANNI | 742410946 - NORTHERN ARIZONA HEALTHCARE CORPORATION | AZ | Facial Plastic Surgery Physician (207YS0123X) |
United | 99457 | $40.05 | 1861855900 - ABBAS NAQVI | 541383504 - TOWN CENTER ORTHOPAEDIC ASSOCIATES, P.C. | FL | Orthopaedic Surgery Physician (207X00000X) |
United | 99457 | $38.65 | 1245261718 - ANGELICA LOZARES | 742793592 - (TX) HEART CLINIC PLLC | TX | Nurse Practitioner (363L00000X) |
United | 99457 | $64.08 | 1306391610 - CAMILLA GRANT | 541383504 - TOWN CENTER ORTHOPAEDIC ASSOCIATES, P.C. | VA | Physical Therapist (225100000X) |
United | 99457 | $127.01 | 1073502985 - CHU CHEN | 42484572 - MERRIMACK VALLEY PEDIATRIC ASSOCIATES, INC. | MA | Pediatrics Physician (208000000X) |
United | 99457 | $115.51 | 1811000177 - CHARLESTON RADIOLOGISTS PA | 570634747 - CHARLESTON RADIOLOGISTS, P.A. | SC | Single Specialty Group (193400000X) |
United | 99457 | $84.36 | 1518964014 - MERRICK MCMAINS | 760460242 - TCH PEDIATRIC ASSOCIATES INC | TX | Pediatrics Physician (208000000X) |
United | 99457 | $75.77 | 1780065342 - SHAILA SHANCHITA | 731388879 - (OK) / COMANCHE COUNTY HEALTHCARE / COMANCHE COUNTY HEALTHCARE CORP | TX | Family Medicine Physician (207Q00000X) |
United | 99457 | $99.52 | 1255598512 - ASTRID HERARD | 910844563 | IL | Psychiatry Physician (2084P0800X) |
United | 99457 | $77.98 | 1689178501 - MEDHA SHARMA | 300520570 - (TX) METHODIST HOSPITAL | TX | Internal Medicine Physician (207R00000X) |
United | 99457 | $81.68 | 1255478004 - CHRISTOPHER RAIO | 112050523 - ST FRANCIS HOSPITAL | NY | Emergency Medicine Physician (207P00000X) |
United | 99457 | $112.73 | 1861650780 - CHILDRENS NATIONAL MEDICAL CENTER | 530196580 - CHILDRENS HOSPITAL | DC | Children's Hospital (282NC2000X) |
United | 99457 | $81.58 | 1306340880 - GEORGE GIANAKAKOS | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | FL | Psychiatry Physician (2084P0800X) |
United | 99457 | $63.27 | 1730214206 - KALYANI GAVINI | 371158318 - (IL) SOUTHERN ILLINOIS HEALTHCARE FOUNDATION INC | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 99457 | $42.50 | 1528021888 - ANDREAS NIKOLAIDIS | 680498355 - (TX) ANDREAS C NIKOLAIDIS MD PA | TX | 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 99457 vs. Other Special Evaluation and Management Services Codes
The CPT 99457 code is part of the Work Related or Medical Disability Evaluation Services 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 99457 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. |
| 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 |
| 99453-CPT | Low | Rem Mntr Physiol Param Setup, 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 |
| 99457-CPT | Low | Rpm Tx Mgmt 1st 20 Min, Remote Physiologic Monitoring Treatment Management Services Clinical Staff/Physician/Other Qualified Health Care Professional Time In A Calendar Month Requiring 1 Real-Time Interactive Communication With The Patient/Caregiver During The Calendar Month; First 20 Minutes |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99457. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99457 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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