CPT 99151

Mod Sed Same Phys/Qhp Initial 15 Mins <5 Yrs

CPT 99151 pays $62.13 in a non-facility setting and $21.04 in a facility setting under the 2026 Medicare Physician Fee Schedule, before geographic adjustment. After geographic adjustment, state amounts run from $55.38 in Arkansas to $72.91 in Alaska, a 32% spread.

National non-facility rate

$62.13

Office and other outpatient settings

Facility rate
$21.04

Hospital and ASC settings

Highest state
$72.91

Alaska

Lowest state
$55.38

Arkansas · 32% spread

Medicare rate by state

53 Medicare jurisdictions, highest to lowest. State values average every locality in the jurisdiction at a 33.4009 conversion factor.

Non-facilityFacilityNational $62.13
CPT 99151 Medicare reimbursement rate by state, 33.4009 conversion factor, 2026 Physician Fee Schedule. National non-facility $62.13, national facility $21.04.
StateRate compared visuallyNon-facilityFacility
Alaska
$72.91$29.16
District of Columbia
$71.05$22.65
California
$70.41$21.79
New Jersey
$68.67$22.41
Washington
$68.66$21.82
New York
$68.41$22.58
Massachusetts
$67.93$21.77
Hawaii
$67.79$21.08
Connecticut
$66.09$21.84
Colorado
$64.95$21.24
Oregon
$64.36$21.08
Maryland
$64.31$21.48
New Hampshire
$63.82$21.05
Rhode Island
$63.80$21.36
Florida
$63.22$22.00
Minnesota
$62.71$20.43
Puerto Rico
$62.60$21.06
Virgin Islands
$62.60$21.06
Montana
$62.12$21.04
Nevada
$62.00$20.88
Wyoming
$61.87$20.78
Illinois
$61.60$21.90
Delaware
$61.57$20.98
North Dakota
$61.53$20.45
South Dakota
$61.46$20.38
Texas
$61.46$21.01
Pennsylvania
$61.43$21.19
Vermont
$61.19$20.51
Virginia
$61.08$20.69
Arizona
$60.60$20.79
Georgia
$60.30$21.11
Michigan
$59.82$21.25
Maine
$59.77$20.52
Wisconsin
$59.57$20.21
Utah
$59.36$20.74
North Carolina
$58.79$20.46
New Mexico
$58.64$20.97
South Carolina
$58.60$20.64
Missouri
$58.45$20.75
Indiana
$58.37$20.28
Louisiana
$58.31$20.80
Ohio
$58.27$20.76
Nebraska
$58.08$20.16
Idaho
$58.04$20.25
Iowa
$57.75$20.15
Tennessee
$57.62$20.27
Kansas
$57.36$20.22
Oklahoma
$57.15$20.46
Kentucky
$57.11$20.59
West Virginia
$56.74$21.04
Alabama
$56.14$20.19
Mississippi
$55.69$20.32
Arkansas
$55.38$20.09

Billed by 1 specialties

Commercial rates for 99151

Medicare is the floor, not the market. See what UHC, Aetna, Cigna and BCBS actually pay — down to the TIN.

See negotiated rates