CPT 99415

Prolonged Clinical Staff Svc Office/O/P 1st Hr

CPT 99415 pays $23.05 in a non-facility setting and $23.05 in a facility setting under the 2026 Medicare Physician Fee Schedule, before geographic adjustment. After geographic adjustment, state amounts run from $19.68 in Arkansas to $27.13 in District of Columbia, a 38% spread.

National non-facility rate

$23.05

Office and other outpatient settings

Facility rate
$23.05

Hospital and ASC settings

Highest state
$27.13

District of Columbia

Lowest state
$19.68

Arkansas · 38% 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 $23.05
CPT 99415 Medicare reimbursement rate by state, 33.4009 conversion factor, 2026 Physician Fee Schedule. National non-facility $23.05, national facility $23.05.
StateRate compared visuallyNon-facilityFacility
District of Columbia
$27.13$27.13
California
$27.06$27.06
Washington
$26.16$26.16
Hawaii
$26.02$26.02
New Jersey
$25.94$25.94
Massachusetts
$25.80$25.80
New York
$25.79$25.79
Connecticut
$24.87$24.87
Colorado
$24.43$24.43
Alaska
$24.37$24.37
Oregon
$24.17$24.17
Maryland
$24.04$24.04
New Hampshire
$23.94$23.94
Rhode Island
$23.76$23.76
Minnesota
$23.47$23.47
Florida
$23.44$23.44
Puerto Rico
$23.29$23.29
Virgin Islands
$23.29$23.29
Montana
$23.05$23.05
Nevada
$23.01$23.01
Wyoming
$22.96$22.96
North Dakota
$22.85$22.85
South Dakota
$22.82$22.82
Delaware
$22.74$22.74
Texas
$22.67$22.67
Vermont
$22.65$22.65
Pennsylvania
$22.60$22.60
Illinois
$22.58$22.58
Virginia
$22.56$22.56
Arizona
$22.29$22.29
Georgia
$22.07$22.07
Maine
$21.91$21.91
Wisconsin
$21.86$21.86
Michigan
$21.80$21.80
Utah
$21.65$21.65
North Carolina
$21.40$21.40
South Carolina
$21.27$21.27
New Mexico
$21.23$21.23
Indiana
$21.22$21.22
Missouri
$21.17$21.17
Louisiana
$21.09$21.09
Nebraska
$21.09$21.09
Ohio
$21.07$21.07
Idaho
$21.05$21.05
Iowa
$20.91$20.91
Tennessee
$20.83$20.83
Kansas
$20.70$20.70
Oklahoma
$20.54$20.54
Kentucky
$20.50$20.50
West Virginia
$20.22$20.22
Alabama
$20.06$20.06
Mississippi
$19.80$19.80
Arkansas
$19.68$19.68

Billed by 1 specialties

Commercial rates for 99415

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

See negotiated rates