CPT code 99151: Moderate sedation, same proceduralist, under five2026 Medicare rate & RVUs

Medicare pays $62.13 for 99151 nationally in the office and $21.04 in a hospital or facility. Local office rates run $55.38–$83.13.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 99151 covers

This code describes moderate sedation delivered by the physician or qualified health professional who also performs the diagnostic or therapeutic procedure. An independent trained observer assists with monitoring the patient’s consciousness and physiologic status. A typical situation is an image-guided procedure, such as a biopsy, when the proceduralist provides the sedation. The patient must be younger than five years.

Report this code for the initial 15-minute intra-service interval. Documentation should identify the patient’s age, the supported procedure, the clinician providing both services, the observer, and sedation start and stop times. Use a different code when another physician or qualified health professional provides the sedation. Additional intra-service time is reported with 99153 when supported by the service and documentation. Medicare fee-schedule valuation is shown separately from this description.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 99151 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

99151 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 99151 rate is calculated

Each of 99151’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for 99151

99151 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.

99151 compared with similar codes

How to choose

99152Moderate sedationSame provider, age 5+, initial period

Both describe initial moderate sedation by the proceduralist; select 99151 for a patient younger than five and 99152 for a patient age five or older.

99155Moderate sedationSeparate clinician, under five

For a patient younger than five, use 99155 when a different physician or qualified health professional provides the sedation rather than the proceduralist.

99153Moderate sedationEach additional 15 minutes

99151 reports the initial 15-minute interval. Code 99153 reports each additional qualifying 15-minute interval.

99156Moderate sedationOther clinician, age 5+

99156 is the initial service when another clinician provides sedation to a patient age five or older; 99151 is for the proceduralist’s sedation of a younger patient.

Codes related to 99151

Related codes aren’t interchangeable: bill the code that matches the service performed.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates