# CPT 99152: Mod Sed Same Phys/qhp Initial 15 Mins 5/> Yrs

Medicare 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.

Web page: https://www.med-reveal.com/rates/99152-cpt-fee-schedule
Section: Medical and Therapeutic Services
Billed by: Emergency Medicine

## Medicare rates

| | Amount |
| --- | --- |
| National non-facility | $51.44 |
| National facility | $11.02 |
| Conversion factor | 33.4009 |
| Release | 2026 Q4 (effective 2026-10-01) |

## By state

| State | Non-facility | Facility |
| --- | --- | --- |
| District of Columbia | $59.49 | $11.88 |
| California | $58.99 | $11.17 |
| Alaska | $57.90 | $14.86 |
| Washington | $57.38 | $11.31 |
| New Jersey | $57.26 | $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 | $52.52 | $11.97 |
| 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 | $11.16 |
| Michigan | $49.28 | $11.33 |
| Maine | $49.19 | $10.58 |
| 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 | $47.83 | $10.93 |
| 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 |

## 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 99152 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