CPT 99494 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 • Psychiatric Collaborative Care Management Services |
| Common Place of Service | • 11 - Office • None • 19 - Off Campus Outpatient Hospital |
| Common Modifiers | • None • 25 - Significant, separately identifiable E/M service same day • 95 - Telemedicine - audio and video |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 99494 |
National average reimbursement for CPT 99494 by major payers:
$69.21
$80.04
$66.71
$107.51
| 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 99494 | ||||||
United | 99494 | $75.55 | 1710500509 - JACKSON REYNOLDS | 453780407 | TX | Family Medicine Physician (207Q00000X) |
United | 99494 | $157.91 | 1033250725 - RAFIC BERBARIE | 756002868 | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99494 | $36.81 | 1598850307 - OBINNA OZIGBO | 474374481 - (TX) ZIMA MEDICAL GROUP PLLC | TX | Internal Medicine Physician (207R00000X) |
United | 99494 | $76.18 | 1528040193 - GARGEYI BANDARU | 810912902 - (TX) VKN HEALTH SERVICES PLLC | TX | Internal Medicine Physician (207R00000X) |
United | 99494 | $70.26 | 1497152078 - NGUYEN PHAM | 464680208 | TX | Internal Medicine Physician (207R00000X) |
United | 99494 | $97.09 | 1427155894 - GRIFFITH THOMAS | 853534045 - (TX) 7007 INDIANA ER PHYSICIANS PLLC | TX | Family Medicine Physician (207Q00000X) |
United | 99494 | $53.65 | 1437370103 - MEDWIN FAMILY MEDICINE & REHABILITATION PC | 920188505 - (TX) MEDWIN FAMILY MEDICINE & REHAB, PC | TX | Family Medicine Physician (207Q00000X) |
United | 99494 | $56.29 | 1184771958 - PAUL SAENZ | 741143128 - (TX) ST MARYS UNIVERSITY OF SAN ANTONIO | TX | Family Medicine Physician (207Q00000X) |
United | 99494 | $157.91 | 1265960827 - HENRY HAN | 756002868 | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99494 | $36.81 | 1043264799 - LISA CLARK | 752045282 | TX | Internal Medicine Physician (207R00000X) |
United | 99494 | $45.47 | 1740570274 - PRAMOD PINNAMANENI | 471548277 - (TX) LUFKIN PHYSICIAN SERVICES PA | TX | Internal Medicine Physician (207R00000X) |
United | 99494 | $36.81 | 1629274295 - SETAL RANA | 261210901 - (TX) SETAL RANA, M.D.P.A. | TX | Family Medicine Physician (207Q00000X) |
United | 99494 | $34.65 | 1568734424 - SUZANNE MILLER | 462718719 - ACCESS TELECARE PLLC | TX | Internal Medicine Physician (207R00000X) |
United | 99494 | $84.31 | 1811001423 - REBECCA SCHNEIDER | 752616977 - CHRISTUS TRINITY CLINIC | TX | Family Medicine Physician (207Q00000X) |
United | 99494 | $47.90 | 1679753826 - MARTIN MBOE | 922943572 - (CA) GLOBAL WOUND CARE MEDICAL GROUP | TX | Family Medicine Physician (207Q00000X) |
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 99494 vs. Other Psychiatric Collaborative Care Management Services Codes
The CPT 99494 code is part of the Evaluation and Management services used for Psychiatric Collaborative Care 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 99494 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 |
|---|---|---|
| 99204-CPT | Moderate | Office Or Other Outpatient Visit For The Evaluation And Management Of A New Patient Which Requires A Medically Appropriate History And/Or Examinationand Moderate Level Of Medical Decision Making. When Using Total Time On The Date Of The Encounter For Code Selection 45 Minutes Must Be Met Or Exceeded. (Desc Rvsd 1/1/2024) |
| 99484-CPT | Low | Care Management Services For Behavioral Health Conditions At Least 20 Minutes Of Clinical Staff Time Directed By A Physician Or Other Qualified Health Care Professional Per Calendar Month Withthe Following Required Elements: Initial Assessment Or Follow-Up Monitoring Including The Use Of Applicable Validated Rating Scales; Behavioral Health Care Planning In Relation To Behavioral/Psychiatric Health Problems Including Revision For Patients Who Are (Desc Rvsd 1/1/22) |
| 99487-CPT | Low | Complex 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 Place The Patient At Significant Risk Of Death, Acute Exacerbation/Decompensation, Or Functional Decline, Comprehensive Care Plan Established, Implemented, Revised, Or Monitored, Moderate Or High Complexity Medical Decision Making;First 60 Minutes Of Clinical Staff Time Directed By A Physician Or Other Qualified Health Care Professional, Per Calendar Month. |
| 99494-CPT | Low | Initial Or Subsequent Psychiatric Collaborative Care Management Each Additional 30 Minutes In A Calendar Month Of Behavioral Health Care Manager Activities In Consultation With A Psychiatric Consultant And Directed By The Treating Physicianor Other Qualified Health Care Professional (List Separately In Addition To Code For Primary Procedure) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99494. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99494 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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