CPT 99152

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

CPT 99152 pays $51.44 in a non-facility setting and $11.02 in a facility setting under the 2026 Medicare Physician Fee Schedule, before geographic adjustment. After geographic adjustment, state amounts run from $45.02 in Arkansas to $59.49 in District of Columbia, a 32% spread.

National non-facility rate

$51.44

Office and other outpatient settings

Facility rate
$11.02

Hospital and ASC settings

Highest state
$59.49

District of Columbia

Lowest state
$45.02

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 $51.44
CPT 99152 Medicare reimbursement rate by state, 33.4009 conversion factor, 2026 Physician Fee Schedule. National non-facility $51.44, national facility $11.02.
StateRate compared visuallyNon-facilityFacility
District of Columbia
$59.49$11.88
California
$58.99$11.17
Alaska
$57.90$14.86
Washington
$57.38$11.31
New Jersey
$57.25$11.75
New York
$57.06$11.97
Hawaii
$56.78$10.83
Massachusetts
$56.72$11.31
Connecticut
$55.06$11.53
Colorado
$54.01$11.01
Oregon
$53.48$10.90
Maryland
$53.41$11.28
New Hampshire
$53.04$10.97
Rhode Island
$52.88$11.13
Florida
$52.53$11.98
Minnesota
$51.95$10.37
Puerto Rico
$51.89$11.03
Virgin Islands
$51.89$11.03
Montana
$51.44$11.02
Nevada
$51.31$10.86
Wyoming
$51.18$10.76
Illinois
$50.96$11.91
Delaware
$50.87$10.94
North Dakota
$50.84$10.43
South Dakota
$50.77$10.36
Texas
$50.76$10.97
Pennsylvania
$50.72$11.13
Vermont
$50.52$10.51
Virginia
$50.43$10.70
Arizona
$49.99$10.83
Georgia
$49.71$11.15
Michigan
$49.28$11.33
Maine
$49.19$10.57
Wisconsin
$48.98$10.26
Utah
$48.81$10.82
North Carolina
$48.26$10.55
New Mexico
$48.15$11.09
South Carolina
$48.09$10.75
Missouri
$47.96$10.87
Indiana
$47.85$10.39
Louisiana
$47.82$10.92
Ohio
$47.78$10.89
Nebraska
$47.57$10.27
Idaho
$47.54$10.36
Iowa
$47.26$10.28
Tennessee
$47.14$10.41
Kansas
$46.90$10.36
Oklahoma
$46.71$10.62
Kentucky
$46.68$10.75
West Virginia
$46.36$11.24
Alabama
$45.74$10.38
Mississippi
$45.33$10.53
Arkansas
$45.02$10.30

Billed by 1 specialties

Commercial rates for 99152

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

See negotiated rates