# CPT 99155: Mod Sed Other Phys/qhp Initial 15 Mins <5 Yrs

Medicare CPT 99155 pays $81.50 in a non-facility setting and $81.50 in a facility setting under the 2026 Medicare Physician Fee Schedule, before geographic adjustment. After geographic adjustment, state amounts run from $75.53 in Wisconsin to $110.28 in Alaska, a 46% spread.

Web page: https://www.med-reveal.com/rates/99155-cpt-fee-schedule
Section: Medical and Therapeutic Services
Billed by: Emergency Medicine

## Medicare rates

| | Amount |
| --- | --- |
| National non-facility | $81.50 |
| National facility | $81.50 |
| Conversion factor | 33.4009 |
| Release | 2026 Q4 (effective 2026-10-01) |

## By state

| State | Non-facility | Facility |
| --- | --- | --- |
| Alaska | $110.28 | $110.28 |
| Florida | $89.12 | $89.12 |
| Illinois | $88.69 | $88.69 |
| New York | $88.55 | $88.55 |
| District of Columbia | $87.61 | $87.61 |
| New Jersey | $86.69 | $86.69 |
| Connecticut | $85.22 | $85.22 |
| Michigan | $84.16 | $84.16 |
| West Virginia | $83.64 | $83.64 |
| Maryland | $83.37 | $83.37 |
| Massachusetts | $83.29 | $83.29 |
| Washington | $83.21 | $83.21 |
| Georgia | $82.71 | $82.71 |
| Pennsylvania | $82.42 | $82.42 |
| New Mexico | $82.28 | $82.28 |
| Rhode Island | $82.17 | $82.17 |
| California | $81.94 | $81.94 |
| Puerto Rico | $81.49 | $81.49 |
| Virgin Islands | $81.49 | $81.49 |
| Montana | $81.48 | $81.48 |
| Colorado | $81.15 | $81.15 |
| Texas | $81.12 | $81.12 |
| Louisiana | $81.01 | $81.01 |
| New Hampshire | $80.91 | $80.91 |
| Delaware | $80.89 | $80.89 |
| Ohio | $80.69 | $80.69 |
| Missouri | $80.55 | $80.55 |
| Oregon | $80.32 | $80.32 |
| Nevada | $80.17 | $80.17 |
| Utah | $80.08 | $80.08 |
| Arizona | $80.03 | $80.03 |
| Kentucky | $79.70 | $79.70 |
| South Carolina | $79.53 | $79.53 |
| Hawaii | $79.50 | $79.50 |
| Wyoming | $79.41 | $79.41 |
| Virginia | $78.97 | $78.97 |
| Oklahoma | $78.64 | $78.64 |
| Maine | $78.06 | $78.06 |
| Mississippi | $78.01 | $78.01 |
| North Carolina | $77.93 | $77.93 |
| Vermont | $77.44 | $77.44 |
| Tennessee | $76.87 | $76.87 |
| Alabama | $76.77 | $76.77 |
| North Dakota | $76.74 | $76.74 |
| Indiana | $76.65 | $76.65 |
| Kansas | $76.56 | $76.56 |
| Idaho | $76.47 | $76.47 |
| Arkansas | $76.20 | $76.20 |
| South Dakota | $76.18 | $76.18 |
| Minnesota | $76.15 | $76.15 |
| Iowa | $75.81 | $75.81 |
| Nebraska | $75.74 | $75.74 |
| Wisconsin | $75.53 | $75.53 |

## 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 99155 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