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See a sample rate comparisonCPT 99601 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 Infus/Specialty Drug Administr Per Visit (Up To 2 Hrs), Home Infusion/Specialty Drug Administration Per Visit (Up To 2 Hours)
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Home Health Procedures and Services |
| Common Place of Service | 99 - Other POS |
| Common Modifiers | SS - Home infusion services provided in the infusion suite of the IV therapy provider 99 - Multiple Modifiers |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 99601 |
| Medicaid Fee Schedule | $68.845 median of the 4 states in the free preview · View Medicaid rates for 99601 |
National average reimbursement for CPT 99601 by major payers:
$123.78
$120.58
$69.26
$125.04
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CPT 99601
5 of 25 sample ratesHigher to lower in this preview
Option Care Enterprises, Inc.
Option Care Health, Inc.
$140.00Published rateCoram Alternate Site Services Inc
$105.00Published rateGreat Lakes Vitality, LLC
Great Lakes Vitality LLC
$100.00Published rateReverence Home Health & Hospice, LLC, Ascension At Home
Reverence Home Health Hospice LLC
$85.00Published rateBronson At Home, Bah Infusion Services
Bronson At Home
$80.00Published rate
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See a sample payer proposalCPT 99601 vs. Other Home Health Procedures and Services Codes
The CPT 99601 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 99601 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 |
|---|---|---|
| 99506-CPT | Low | Home Visit For Intramuscular Injections |
| 99600-CPT | Moderate | Home Visit Service, A Visit Or Treatment In The Home By A Health Care Professional. |
| 99601-CPT | Low | Home Infus/Specialty Drug Administr Per Visit (Up To 2 Hrs), Home Infusion/Specialty Drug Administration Per Visit (Up To 2 Hours) |
| 99602-CPT | Low | Home Nfs Visit Each Addl Hr, Home Infusion/Specialty Drug Administration Per Visit (Up To 2 Hours); Each Additional Hour (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 99601. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99601 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
To find the cost of a specific medical procedure, you can use online tools that provide fee schedule lookups. For a comprehensive search by CPT code and specific location, you can utilize platforms like Payerprice. Additionally, you should contact your insurance provider to understand your out-of-pocket costs, deductibles, and co-pays. Many hospitals and healthcare providers also offer price estimates upon request.
Several factors influence the price of a healthcare service, including the type of service, the provider's reputation and location (e.g., hospital vs. outpatient clinic), the complexity of the procedure, geographic region, whether the provider is in-network or out-of-network for your insurance, and negotiated rates with insurance companies. Facility fees, physician fees, and charges for supplies or medication all contribute to the final cost.
Healthcare prices are generally not standardized and can vary significantly by provider, location, and even between different insurance plans. Factors like a provider's negotiated rates with insurers, their cost of operation, and the local market all contribute to these variations. It's crucial to research and compare prices for the same service across different facilities.
CPT stands for Current Procedural Terminology. CPT codes are a set of medical codes used by physicians and other healthcare providers to report medical, surgical, and diagnostic services and procedures to entities such as health insurance companies and accreditation organizations. They are essential for accurate billing, processing claims, and tracking healthcare services, allowing for standardized communication about medical procedures.
To compare prices for medical services, you should first obtain the CPT codes for the services you need. Then, you can use platforms like Payerprice, which allow you to search for fee schedules by CPT code and specific location. Additionally, contact your insurance company for in-network estimates and ask providers directly for Good Faith Estimates under the No Surprises Act.
If you receive a medical bill that seems too high, first review it carefully for accuracy, checking for duplicate charges or services you didn't receive. Then, contact your insurance company to understand what they covered and why. Next, reach out to the healthcare provider's billing department to dispute charges, negotiate a lower price, or discuss payment plans. You can also compare the billed price to fair market rates using tools like Payerprice to support your case.
It is rare for insurance to cover the full cost of a procedure. Most insurance plans involve out-of-pocket expenses such as deductibles, co-pays, and co-insurance, which you are responsible for paying. The extent of coverage depends on your specific plan, whether the provider is in-network, and if you have met your deductible and out-of-pocket maximums. Always contact your insurance provider directly to understand your specific benefits and coverage for any planned procedure.
Information about fee schedules for medical services can be found through various resources. For specific CPT codes and locations, Payerprice offers a dedicated lookup tool. Your insurance provider can also supply information regarding their contracted rates for specific services. Additionally, under price transparency regulations, many hospitals and providers are required to post their standard charges online, though these may not reflect the actual out-of-pocket cost.
Price transparency in healthcare refers to initiatives and regulations aimed at making the costs of medical services more accessible and understandable to consumers. The goal is to empower patients to make informed decisions by allowing them to compare prices before receiving care. Examples include regulations requiring hospitals to publish standard charges and insurers to provide price comparison tools for their members.