# CPT 99415: Prolonged Clinical Staff Svc Office/o/p 1st Hr

Medicare 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.

Web page: https://www.med-reveal.com/rates/99415-cpt-fee-schedule
Section: Evaluation and Management
Billed by: Evaluation

## Medicare rates

| | Amount |
| --- | --- |
| National non-facility | $23.05 |
| National facility | $23.05 |
| Conversion factor | 33.4009 |
| Release | 2026 Q4 (effective 2026-10-01) |

## By state

| State | Non-facility | Facility |
| --- | --- | --- |
| 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 | $22.61 | $22.61 |
| Illinois | $22.59 | $22.59 |
| 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 |

## 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
- 99358: Prolng E/m Svc Before&/after Dir Pt Care 1st Hr — https://www.med-reveal.com/rates/99358-cpt-fee-schedule
- 99359: Prolng E/m Before&/after Dir Care Ea 30 Minutes — https://www.med-reveal.com/rates/99359-cpt-fee-schedule

Commercial negotiated rates for 99415 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