# CPT 99156: Mod Sed Other Phys/qhp Initial 15 Mins 5/> Yrs

Medicare CPT 99156 pays $71.14 in a non-facility setting and $71.14 in a facility setting under the 2026 Medicare Physician Fee Schedule, before geographic adjustment. After geographic adjustment, state amounts run from $66.35 in Wisconsin to $96.48 in Alaska, a 45% spread.

Web page: https://www.med-reveal.com/rates/99156-cpt-fee-schedule
Section: Medical and Therapeutic Services
Billed by: Emergency Medicine

## Medicare rates

| | Amount |
| --- | --- |
| National non-facility | $71.14 |
| National facility | $71.14 |
| Conversion factor | 33.4009 |
| Release | 2026 Q4 (effective 2026-10-01) |

## By state

| State | Non-facility | Facility |
| --- | --- | --- |
| Alaska | $96.48 | $96.48 |
| Florida | $77.18 | $77.18 |
| New York | $77.16 | $77.16 |
| Illinois | $76.79 | $76.79 |
| District of Columbia | $76.56 | $76.56 |
| New Jersey | $75.73 | $75.73 |
| Connecticut | $74.32 | $74.32 |
| Michigan | $73.14 | $73.14 |
| Massachusetts | $72.91 | $72.91 |
| Washington | $72.90 | $72.90 |
| Maryland | $72.77 | $72.77 |
| West Virginia | $72.61 | $72.61 |
| Georgia | $72.03 | $72.03 |
| California | $71.99 | $71.99 |
| Pennsylvania | $71.88 | $71.88 |
| Rhode Island | $71.83 | $71.83 |
| New Mexico | $71.62 | $71.62 |
| Puerto Rico | $71.16 | $71.16 |
| Virgin Islands | $71.16 | $71.16 |
| Montana | $71.13 | $71.13 |
| Colorado | $71.04 | $71.04 |
| Texas | $70.85 | $70.85 |
| New Hampshire | $70.75 | $70.75 |
| Delaware | $70.66 | $70.66 |
| Louisiana | $70.60 | $70.60 |
| Ohio | $70.35 | $70.35 |
| Oregon | $70.35 | $70.35 |
| Missouri | $70.25 | $70.25 |
| Nevada | $70.09 | $70.09 |
| Arizona | $69.93 | $69.93 |
| Utah | $69.92 | $69.92 |
| Hawaii | $69.80 | $69.80 |
| Kentucky | $69.53 | $69.53 |
| Wyoming | $69.49 | $69.49 |
| South Carolina | $69.46 | $69.46 |
| Virginia | $69.11 | $69.11 |
| Oklahoma | $68.69 | $68.69 |
| Maine | $68.35 | $68.35 |
| North Carolina | $68.20 | $68.20 |
| Mississippi | $68.14 | $68.14 |
| Vermont | $67.91 | $67.91 |
| North Dakota | $67.37 | $67.37 |
| Tennessee | $67.32 | $67.32 |
| Alabama | $67.18 | $67.18 |
| Indiana | $67.17 | $67.17 |
| Kansas | $67.07 | $67.07 |
| Idaho | $67.02 | $67.02 |
| Minnesota | $66.96 | $66.96 |
| South Dakota | $66.93 | $66.93 |
| Arkansas | $66.70 | $66.70 |
| Iowa | $66.49 | $66.49 |
| Nebraska | $66.45 | $66.45 |
| Wisconsin | $66.35 | $66.35 |

## 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 99156 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