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See a sample rate comparisonCPT 99504 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.
Home Ventilator Services, Home Visit To Provide Mechanical Ventilator Care And To Address Any Related Issues Such As Oxygen And Care Of A Tracheostomy.
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Home Health Procedures and Services |
| Common Place of Service | 99 - Other POS |
| Common Modifiers | TD TE |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 99504 |
| Medicaid Fee Schedule | View Medicaid rates for 99504 |
National average reimbursement for CPT 99504 by major payers:
$67.79
$50.00
$25.00
$78.24
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CPT 99504
5 of 25 sample ratesHigher to lower in this preview
Crosbyton Clinic Hospital
$1,272.00Published rateDa Pediatric Rehabilitation
$60.00Published rateAll Ways Homecare Inc
$55.00Published rateRestorative Health Rehabilitation Inc
$40.00Published rateAll Ways Homecare Inc
$35.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 99504 vs. Other Home Health Procedures and Services Codes
The CPT 99504 code is part of the Medicine Services and Procedures services used for Home Health Procedures and 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 99504 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 |
|---|---|---|
| 99503-CPT | Low | Home Breathing Therapy, Home Visit For Care Related To A Breathing Condition. The Visit Can Include Education Therapy Medication Management And Equipment Calibration. |
| 99504-CPT | Low | Home Ventilator Services, Home Visit To Provide Mechanical Ventilator Care And To Address Any Related Issues Such As Oxygen And Care Of A Tracheostomy. |
| 99505-CPT | Low | Home Visit For Stoma Care, Home Visit For Care Of Stoma (Surgically Created Opening In The Skin) And Maintenance Of Colostomy (Opening In Abdomen From Large Intestine) Or Cystoma (Opening In Abdominal Wall For Drainage Of Urine From Bladder). |
| 99600-CPT | Moderate | Home Visit Service, A Visit Or Treatment In The Home By A Health Care Professional. |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99504. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99504 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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