# CPT 99358: Prolng E/m Svc Before&/after Dir Pt Care 1st Hr

Medicare CPT 99358 pays $91.85 in a non-facility setting and $76.82 in a facility setting under the 2026 Medicare Physician Fee Schedule, before geographic adjustment. After geographic adjustment, state amounts run from $86.11 in Arkansas to $122.09 in Alaska, a 42% spread.

Web page: https://www.med-reveal.com/rates/99358-cpt-fee-schedule
Section: Evaluation and Management
Billed by: Emergency Medicine, Evaluation, Hematology & Oncology, Optometrist, Psychiatry & Neurology, Psychoanalyst, Sleep Medicine

## Medicare rates

| | Amount |
| --- | --- |
| National non-facility | $91.85 |
| National facility | $76.82 |
| Conversion factor | 33.4009 |
| Release | 2026 Q4 (effective 2026-10-01) |

## By state

| State | Non-facility | Facility |
| --- | --- | --- |
| Alaska | $122.09 | $106.08 |
| District of Columbia | $100.51 | $82.80 |
| New York | $99.27 | $82.50 |
| New Jersey | $98.79 | $81.86 |
| California | $97.47 | $79.68 |
| Washington | $96.90 | $79.77 |
| Massachusetts | $96.46 | $79.57 |
| Connecticut | $95.99 | $79.80 |
| Florida | $95.43 | $80.34 |
| Illinois | $94.46 | $79.94 |
| Hawaii | $94.15 | $77.06 |
| Maryland | $94.11 | $78.44 |
| Colorado | $93.56 | $77.57 |
| Rhode Island | $93.52 | $78.00 |
| Oregon | $92.82 | $76.99 |
| New Hampshire | $92.54 | $76.90 |
| Puerto Rico | $92.11 | $76.91 |
| Virgin Islands | $92.11 | $76.91 |
| Pennsylvania | $92.07 | $77.35 |
| Montana | $91.85 | $76.81 |
| Michigan | $91.64 | $77.53 |
| Texas | $91.49 | $76.69 |
| Delaware | $91.45 | $76.60 |
| Georgia | $91.38 | $77.04 |
| Nevada | $91.27 | $76.22 |
| Wyoming | $90.90 | $75.87 |
| Arizona | $90.45 | $75.89 |
| Virginia | $90.30 | $75.52 |
| New Mexico | $90.26 | $76.48 |
| Minnesota | $90.08 | $74.61 |
| Utah | $89.79 | $75.67 |
| Vermont | $89.76 | $74.88 |
| West Virginia | $89.76 | $76.70 |
| North Dakota | $89.67 | $74.64 |
| Louisiana | $89.59 | $75.86 |
| Missouri | $89.49 | $75.69 |
| Ohio | $89.44 | $75.72 |
| South Dakota | $89.41 | $74.38 |
| Maine | $89.23 | $74.87 |
| South Carolina | $89.17 | $75.28 |
| North Carolina | $88.65 | $74.62 |
| Kentucky | $88.43 | $75.06 |
| Wisconsin | $88.13 | $73.73 |
| Oklahoma | $88.03 | $74.61 |
| Indiana | $87.92 | $73.98 |
| Idaho | $87.67 | $73.84 |
| Tennessee | $87.60 | $73.94 |
| Nebraska | $87.41 | $73.53 |
| Kansas | $87.34 | $73.75 |
| Iowa | $87.25 | $73.50 |
| Mississippi | $86.99 | $74.05 |
| Alabama | $86.75 | $73.60 |
| Arkansas | $86.11 | $73.20 |

## Related codes

- 99201: New Patient Office Visit: Coverage and Documentation Requirements — https://www.med-reveal.com/rates/99201-cpt-fee-schedule
- 99241: Office consultation for a new or established patient that requires these three key components: a problem-focused history; a problem-focused examination; and straightforward medical decision-making — https://www.med-reveal.com/rates/99241-cpt-fee-schedule
- 99251: Inpatient consultation for a new or established patient which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. — https://www.med-reveal.com/rates/99251-cpt-fee-schedule
- 99288: Phys/qhp Direction Emergency Medical Systems — https://www.med-reveal.com/rates/99288-cpt-fee-schedule
- 99354: Prolonged Service With Direct Patient Contact — https://www.med-reveal.com/rates/99354-cpt-fee-schedule
- 99355: Prolonged Service With Direct Patient Contact — https://www.med-reveal.com/rates/99355-cpt-fee-schedule
- 99359: Prolng E/m Before&/after Dir Care Ea 30 Minutes — https://www.med-reveal.com/rates/99359-cpt-fee-schedule
- 99360: Phys Standby Svc Prolng Phys Attn Ea 30 Minutes — https://www.med-reveal.com/rates/99360-cpt-fee-schedule

Commercial negotiated rates for 99358 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