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See a sample rate comparisonCPT 99511 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 Visit For Constipation, Home Visit To Treat Constipation (Inability To Pass Stool) May Include The Administration Of An Enema And/Or Manual Removal Of Feces By A Health Care Professional.
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Home Health Procedures and Services |
| Common Place of Service | 99 - Other POS 11 - Office |
| Common Modifiers | 59 - Distinct Procedural Service |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 99511 |
National average reimbursement for CPT 99511 by major payers:
$67.79
$40.00
$25.00
$73.77
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CPT 99511
5 of 25 sample ratesHigher to lower in this preview
Crosbyton Clinic Hospital
$1,272.00Published rateDa Pediatric Rehabilitation
$55.00Published rateAll Ways Homecare Inc
$40.00Published rateDa Pediatric Rehabilitation
$35.00Published rateDa Pediatric Rehabilitation
$35.00Published rate
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See a sample payer proposalCPT 99511 vs. Other Home Health Procedures and Services Codes
The CPT 99511 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 99511 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 |
|---|---|---|
| 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). |
| 99507-CPT | Low | Home Visit For Care & Maintenan Of Cathet(S) (Eg Urinary Drain, Home Visit For Care And Maintenance Of Catheter(S) (Eg Urinary Drain |
| 99509-CPT | Low | Home Visit For Assistan W/ Activiti Of Daily Living & Personal, Home Visit For Assistance With Activities Of Daily Living And Personal |
| 99511-CPT | Low | Home Visit For Constipation, Home Visit To Treat Constipation (Inability To Pass Stool) May Include The Administration Of An Enema And/Or Manual Removal Of Feces 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 99511. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99511 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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