# CPT 99151: Mod Sed Same Phys/qhp Initial 15 Mins <5 Yrs

Medicare 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.

Web page: https://www.med-reveal.com/rates/99151-cpt-fee-schedule
Section: Medical and Therapeutic Services
Billed by: Emergency Medicine

## Medicare rates

| | Amount |
| --- | --- |
| National non-facility | $62.13 |
| National facility | $21.04 |
| Conversion factor | 33.4009 |
| Release | 2026 Q4 (effective 2026-10-01) |

## By state

| State | Non-facility | Facility |
| --- | --- | --- |
| Alaska | $72.91 | $29.16 |
| District of Columbia | $71.05 | $22.65 |
| California | $70.41 | $21.79 |
| New Jersey | $68.66 | $22.41 |
| Washington | $68.66 | $21.83 |
| New York | $68.41 | $22.58 |
| Massachusetts | $67.93 | $21.78 |
| 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 | $61.44 | $21.19 |
| Vermont | $61.19 | $20.51 |
| Virginia | $61.08 | $20.69 |
| Arizona | $60.60 | $20.79 |
| Georgia | $60.31 | $21.11 |
| Michigan | $59.83 | $21.24 |
| Maine | $59.78 | $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 |

## Related codes

- 90632: Hepa Vaccine Adult Dose for Intramuscular Use — https://www.med-reveal.com/rates/90632-cpt-fee-schedule
- 90633: Hepa Vaccine 2 Dose Schedule Ped/adolesc Im Use — https://www.med-reveal.com/rates/90633-cpt-fee-schedule
- 90647: Hib Prp-omp Vaccine 3 Dose Schedule Im Use — https://www.med-reveal.com/rates/90647-cpt-fee-schedule
- 90648: Hib Prp-t Vaccine 4 Dose Schedule Im Use — https://www.med-reveal.com/rates/90648-cpt-fee-schedule
- 90680: Rv5 Vaccine 3 Dose Schedule Live for Oral Use — https://www.med-reveal.com/rates/90680-cpt-fee-schedule
- 90681: Rv1 Vaccine 2 Dose Schedule Live for Oral Use — https://www.med-reveal.com/rates/90681-cpt-fee-schedule
- 90698: Dtap-ipv/hib Vaccine for Intramuscular Use — https://www.med-reveal.com/rates/90698-cpt-fee-schedule
- 90710: Measles Mumps Rubella Varicella Vacc Live Subq — https://www.med-reveal.com/rates/90710-cpt-fee-schedule

Commercial negotiated rates for 99151 by payer and state: https://www.med-reveal.com/solutions/rate-benchmarking

## Sources

- CMS Medicare fee schedules (2026 Q4): https://www.cms.gov/medicare/payment/fee-schedules