CPT code 99151: Moderate sedation, same proceduralist, under five2026 Medicare rate & RVUs in West Virginia
Moderate sedation performed by the procedure’s physician or qualified health professional for a patient younger than five, during the initial time interval.
In West Virginia, Medicare pays $56.74 for 99151 in the office and $21.04 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 99151 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
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.
How West Virginia compares for 99151
Across 109 of 109 payment localities, the office rate for 99151 runs from $55.38 in Arkansas to $83.13 in San Benito County, CA. West Virginia pays $56.74. The RVUs are the same everywhere; the geographic indexes change the dollars.
- West Virginia · this page$56.74
- Los Angeles, CA · California$70.60+$13.86
- Washington, DC area · District of Columbia$71.05+$14.31
- Miami, FL · Florida$65.48+$8.74
- Chicago, IL · Illinois$63.76+$7.02
- Manhattan, NY · New York$70.98+$14.24
- Alaska · Alaska$72.91+$16.17
Other areas in West Virginia first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $56.14 | $20.19 |
| ArkansasArkansas | $55.38 | $20.09 |
| ArizonaArizona | $60.60 | $20.79 |
| Bakersfield, CACalifornia | $66.32 | $21.29 |
| Chico, CACalifornia | $66.21 | $21.18 |
| El Centro, CACalifornia | $66.21 | $21.19 |
| Fresno, CACalifornia | $66.21 | $21.18 |
| Hanford, CACalifornia | $66.21 | $21.18 |
| Madera, CACalifornia | $66.21 | $21.18 |
| Merced, CACalifornia | $66.21 | $21.18 |
| Modesto, CACalifornia | $66.21 | $21.18 |
| Napa, CACalifornia | $76.81 | $22.66 |
| Oxnard, CACalifornia | $70.30 | $21.74 |
| Redding, CACalifornia | $66.21 | $21.18 |
| Rest of CaliforniaCalifornia | $66.21 | $21.18 |
| Riverside, CACalifornia | $66.54 | $21.52 |
| Sacramento, CACalifornia | $69.50 | $21.72 |
| Salinas, CACalifornia | $69.24 | $21.63 |
| San Diego, CACalifornia | $70.87 | $21.74 |
| Marin County, CACalifornia | $81.38 | $23.46 |
| San Francisco, CACalifornia | $81.35 | $23.42 |
| San Benito County, CACalifornia | $83.13 | $23.89 |
| Santa Clara County, CACalifornia | $82.99 | $23.75 |
| San Luis Obispo, CACalifornia | $68.12 | $21.33 |
| Santa Cruz, CACalifornia | $71.56 | $21.65 |
| Santa Maria, CACalifornia | $69.50 | $21.60 |
| Santa Rosa, CACalifornia | $72.29 | $21.84 |
| Stockton, CACalifornia | $66.21 | $21.18 |
| Vallejo, CACalifornia | $76.76 | $22.61 |
| Visalia, CACalifornia | $66.21 | $21.18 |
| Yuba City, CACalifornia | $66.21 | $21.18 |
| ColoradoColorado | $64.95 | $21.24 |
| ConnecticutConnecticut | $66.09 | $21.84 |
| DelawareDelaware | $61.57 | $20.98 |
| Fort Lauderdale, FLFlorida | $63.51 | $21.90 |
| Rest of FloridaFlorida | $60.68 | $21.40 |
| Atlanta, GAGeorgia | $63.09 | $21.35 |
| Rest of GeorgiaGeorgia | $57.52 | $20.87 |
| Hawaii, Guam, HIHawaii | $67.79 | $21.08 |
| IowaIowa | $57.75 | $20.15 |
| IdahoIdaho | $58.04 | $20.25 |
| East St. Louis, ILIllinois | $59.59 | $21.79 |
| Rest of IllinoisIllinois | $58.82 | $21.32 |
| Suburban Chicago, ILIllinois | $64.22 | $22.02 |
| IndianaIndiana | $58.37 | $20.28 |
| KansasKansas | $57.36 | $20.22 |
| KentuckyKentucky | $57.11 | $20.59 |
| New Orleans, LALouisiana | $59.64 | $20.98 |
| Rest of LouisianaLouisiana | $56.97 | $20.62 |
| Metropolitan Boston, MAMassachusetts | $71.32 | $22.27 |
| Rest of MassachusettsMassachusetts | $64.54 | $21.28 |
| Baltimore area, MDMaryland | $65.87 | $21.79 |
| Rest of MarylandMaryland | $62.74 | $21.17 |
| Rest of MaineMaine | $58.19 | $20.40 |
| Southern Maine, MEMaine | $61.36 | $20.64 |
| Detroit, MIMichigan | $61.26 | $21.61 |
| Rest of MichiganMichigan | $58.39 | $20.88 |
| MinnesotaMinnesota | $62.71 | $20.43 |
| Metropolitan Kansas City, MOMissouri | $59.39 | $20.82 |
| Metropolitan St. Louis, MOMissouri | $60.00 | $20.88 |
| Rest of MissouriMissouri | $55.97 | $20.56 |
| MississippiMississippi | $55.69 | $20.32 |
| MontanaMontana | $62.12 | $21.04 |
| North CarolinaNorth Carolina | $58.79 | $20.46 |
| North DakotaNorth Dakota | $61.53 | $20.45 |
| NebraskaNebraska | $58.08 | $20.16 |
| New HampshireNew Hampshire | $63.82 | $21.05 |
| Northern New JerseyNew Jersey | $70.35 | $22.70 |
| Rest of New JerseyNew Jersey | $66.98 | $22.12 |
| New MexicoNew Mexico | $58.64 | $20.97 |
| NevadaNevada | $62.00 | $20.88 |
| NYC suburbs and Long Island, NYNew York | $72.45 | $23.60 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $67.31 | $22.32 |
| Queens, NYNew York | $71.72 | $23.16 |
| Rest of New YorkNew York | $59.61 | $20.58 |
| OhioOhio | $58.27 | $20.76 |
| OklahomaOklahoma | $57.15 | $20.46 |
| Portland, OROregon | $67.07 | $21.42 |
| Rest of OregonOregon | $61.65 | $20.73 |
| Metropolitan Philadelphia, PAPennsylvania | $64.44 | $21.67 |
| Rest of PennsylvaniaPennsylvania | $58.43 | $20.71 |
| Puerto RicoPuerto Rico | $62.60 | $21.06 |
| Rhode IslandRhode Island | $63.80 | $21.36 |
| South CarolinaSouth Carolina | $58.60 | $20.64 |
| South DakotaSouth Dakota | $61.46 | $20.38 |
| TennesseeTennessee | $57.62 | $20.27 |
| Austin, TXTexas | $64.62 | $21.16 |
| Beaumont, TXTexas | $58.06 | $20.67 |
| Brazoria, TXTexas | $61.64 | $20.93 |
| Dallas, TXTexas | $61.96 | $21.04 |
| Fort Worth, TXTexas | $61.52 | $21.02 |
| Galveston, TXTexas | $61.78 | $20.98 |
| Houston, TXTexas | $62.33 | $21.53 |
| Rest of TexasTexas | $59.76 | $20.78 |
| UtahUtah | $59.36 | $20.74 |
| VirginiaVirginia | $61.08 | $20.69 |
| Virgin Islands, VIUnited States Virgin Islands | $62.60 | $21.06 |
| VermontVermont | $61.19 | $20.51 |
| Rest of WashingtonWashington | $64.46 | $21.20 |
| King County, WAWashington | $72.86 | $22.45 |
| WisconsinWisconsin | $59.57 | $20.21 |
| WyomingWyoming | $61.87 | $20.78 |
99151 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$55.38
$74.67
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $72.91 | 1 |
| AL | $56.14 | 1 |
| AR | $55.38 | 1 |
| AZ | $60.60 | 1 |
| CA | $66.21–$83.13 | 29 |
| CO | $64.95 | 1 |
| CT | $66.09 | 1 |
| DC | $71.05 | 1 |
| DE | $61.57 | 1 |
| FL | $60.68–$65.48 | 3 |
| GA | $57.52–$63.09 | 2 |
| GU | $67.79 | 1 |
| HI | $67.79 | 1 |
| IA | $57.75 | 1 |
| ID | $58.04 | 1 |
| IL | $58.82–$64.22 | 4 |
| IN | $58.37 | 1 |
| KS | $57.36 | 1 |
| KY | $57.11 | 1 |
| LA | $56.97–$59.64 | 2 |
| MA | $64.54–$71.32 | 2 |
| MD | $62.74–$71.05 | 3 |
| ME | $58.19–$61.36 | 2 |
| MI | $58.39–$61.26 | 2 |
| MN | $62.71 | 1 |
| MO | $55.97–$60.00 | 3 |
| MS | $55.69 | 1 |
| MT | $62.12 | 1 |
| NC | $58.79 | 1 |
| ND | $61.53 | 1 |
| NE | $58.08 | 1 |
| NH | $63.82 | 1 |
| NJ | $66.98–$70.35 | 2 |
| NM | $58.64 | 1 |
| NV | $62.00 | 1 |
| NY | $59.61–$72.45 | 5 |
| OH | $58.27 | 1 |
| OK | $57.15 | 1 |
| OR | $61.65–$67.07 | 2 |
| PA | $58.43–$64.44 | 2 |
| PR | $62.60 | 1 |
| RI | $63.80 | 1 |
| SC | $58.60 | 1 |
| SD | $61.46 | 1 |
| TN | $57.62 | 1 |
| TX | $58.06–$64.62 | 8 |
| UT | $59.36 | 1 |
| VA | $61.08–$71.05 | 2 |
| VI | $62.60 | 1 |
| VT | $61.19 | 1 |
| WA | $64.46–$72.86 | 2 |
| WI | $59.57 | 1 |
| WV | $56.74 | 1 |
| WY | $61.87 | 1 |
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.
How the rate is built · 99151
RVUs × geographic indexes × conversion factor
Work0.50
0.50 RVUs× 1.000 GPCI
Practice expense1.33
1.33 RVUs× 1.000 GPCI
Malpractice0.03
0.03 RVUs× 1.000 GPCI
Adjusted RVUs
1.8600
Conversion factor
$33.4009
Medicare rate
$62.13
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact West Virginia inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
12,989
- Code
- 99151
- Physician work
- 0.50
- Practice expense
- 1.33
- Malpractice
- 0.03
GPCI2026.csv
110
- Locality
- West Virginia
- Physician work
- 1.000
- Practice expense
- 0.869
- Malpractice
- 1.431
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.50 | × 1.000 | 0.5000 |
| Practice expense | 1.33 | × 0.869 | 1.1558 |
| Malpractice | 0.03 | × 1.431 | 0.0429 |
| Total RVUs | 1.6987 | ||
| Conversion factor | × 33.4009 | ||
Office rate, West Virginia$56.74
Office: (0.5 × 1 + 1.33 × 0.869 + 0.03 × 1.431) × $33.4009 = $56.74
Facility: (0.5 × 1 + 0.1 × 0.869 + 0.03 × 1.431) × $33.4009 = $21.04
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.
Place of service · 99151
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$62.13
- Non-facility (office)
- $62.13
- Facility
- $21.04
Higher because the practice carries its own overhead.
How 99151 has changed in West Virginia
99151 · Office / nonfacility
$56.74
Effective 2026-10-01
The base rate is $4.14 higher than on 2025-10-01, moving from $52.60 to $56.74 (7.9%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
January 1, 2026
RVU26A
$52.60changed to$56.74
- Conversion factor 32.3465 changed to 33.4009
- Practice expense RVU 1.26 changed to 1.33
- Practice expense GPCI 0.862 changed to 0.869
- Malpractice GPCI 1.333 changed to 1.431
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$54.99changed to$52.60
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 1.29 changed to 1.26
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$54.09changed to$54.99
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$55.38changed to$54.09
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 1.26 changed to 1.29
- Malpractice RVU 0.04 changed to 0.03
- Practice expense GPCI 0.860 changed to 0.862
- Malpractice GPCI 1.266 changed to 1.333
January 1, 2023
RVU23A
$64.09changed to$55.38
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 1.52 changed to 1.26
- Practice expense GPCI 0.858 changed to 0.860
- Malpractice GPCI 1.198 changed to 1.266
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$79.11changed to$64.09
- Conversion factor 34.8931 changed to 34.6062
- Practice expense RVU 1.99 changed to 1.52
- Malpractice RVU 0.05 changed to 0.04
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$68.23changed to$79.11
- Conversion factor 36.0896 changed to 34.8931
- Practice expense RVU 1.55 changed to 1.99
- Practice expense GPCI 0.857 changed to 0.858
- Malpractice GPCI 1.247 changed to 1.198
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$68.85changed to$68.23
- Conversion factor 36.0391 changed to 36.0896
- Practice expense RVU 1.57 changed to 1.55
- Malpractice GPCI 1.296 changed to 1.247
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
$71.24changed to$68.85
- Conversion factor 35.9996 changed to 36.0391
- Practice expense RVU 1.65 changed to 1.57
Held through RVU19B, RVU19C, RVU19D.
January 1, 2018
RVU18AR1
$69.81changed to$71.24
- Conversion factor 35.8887 changed to 35.9996
- Practice expense RVU 1.63 changed to 1.65
- Practice expense GPCI 0.847 changed to 0.857
- Malpractice GPCI 1.289 changed to 1.296
Held through RVU18B, RVU18C, RVU18D.
January 1, 2017
RVU17A
No ratechanged to$69.81
Held through RVU17B, RVU17C, RVU17D.
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C, RVU13D, RVU14A, RVU14B, RVU14C, RVU14D, RVU15A, RVU15B, RVU15C, RVU15D, RVU16A, RVU16B, RVU16C, RVU16D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $56.74 | $21.04 | RVU26D |
| 2026-07-01 | $56.74 | $21.04 | RVU26C |
| 2026-04-01 | $56.74 | $21.04 | RVU26B |
| 2026-01-01 | $56.74 | $21.04 | RVU26A |
| 2025-10-01 | $52.60 | $22.49 | RVU25D |
| 2025-07-01 | $52.60 | $22.49 | RVU25C |
| 2025-04-01 | $52.60 | $22.49 | RVU25B |
| 2025-01-01 | $52.60 | $22.49 | RVU25A |
| 2024-10-01 | $54.99 | $23.14 | RVU24D |
| 2024-07-01 | $54.99 | $23.14 | RVU24C |
| 2024-04-01 | $54.99 | $23.14 | RVU24B |
| 2024-03-09 | $54.99 | $23.14 | RVU24AR |
| 2024-01-01 | $54.09 | $22.76 | RVU24A |
| 2023-10-01 | $55.38 | $23.91 | RVU23D |
| 2023-07-01 | $55.38 | $23.91 | RVU23C |
| 2023-04-01 | $55.38 | $23.91 | RVU23B |
| 2023-01-01 | $55.38 | $23.91 | RVU23A |
| 2022-10-01 | $64.09 | $24.60 | RVU22D |
| 2022-07-01 | $64.09 | $24.60 | RVU22C |
| 2022-04-01 | $64.09 | $24.60 | RVU22B |
| 2022-01-01 | $64.09 | $24.60 | RVU22A |
| 2021-10-01 | $79.11 | $24.93 | RVU21D |
| 2021-07-01 | $79.11 | $24.93 | RVU21C |
| 2021-04-01 | $79.11 | $24.93 | RVU21B |
| 2021-01-01 | $79.11 | $24.93 | RVU21A |
| 2020-10-01 | $68.23 | $24.01 | RVU20D |
| 2020-07-01 | $68.23 | $24.01 | RVU20C |
| 2020-04-01 | $68.23 | $24.01 | RVU20B |
| 2020-01-01 | $68.23 | $24.01 | RVU20A |
| 2019-10-01 | $68.85 | $25.61 | RVU19D |
| 2019-07-01 | $68.85 | $25.61 | RVU19C |
| 2019-04-01 | $68.85 | $25.61 | RVU19B |
| 2019-01-01 | $68.85 | $25.61 | RVU19A |
| 2018-10-01 | $71.24 | $24.96 | RVU18D |
| 2018-07-01 | $71.24 | $24.96 | RVU18C |
| 2018-04-01 | $71.24 | $24.96 | RVU18B |
| 2018-01-01 | $71.24 | $24.96 | RVU18AR1 |
| 2017-10-01 | $69.81 | $23.91 | RVU17D |
| 2017-07-01 | $69.81 | $23.91 | RVU17C |
| 2017-04-01 | $69.81 | $23.91 | RVU17B |
| 2017-01-01 | $69.81 | $23.91 | RVU17A |
| 2016-10-01 | Not in this release | Not in this release | RVU16D |
| 2016-07-01 | Not in this release | Not in this release | RVU16C |
| 2016-04-01 | Not in this release | Not in this release | RVU16B |
| 2016-01-01 | Not in this release | Not in this release | RVU16A |
| 2015-10-01 | Not in this release | Not in this release | RVU15D |
| 2015-07-01 | Not in this release | Not in this release | RVU15C |
| 2015-04-01 | Not in this release | Not in this release | RVU15B |
| 2015-01-01 | Not in this release | Not in this release | RVU15A |
| 2014-10-01 | Not in this release | Not in this release | RVU14D |
| 2014-07-01 | Not in this release | Not in this release | RVU14C |
| 2014-04-01 | Not in this release | Not in this release | RVU14B |
| 2014-01-01 | Not in this release | Not in this release | RVU14A |
| 2013-10-01 | Not in this release | Not in this release | RVU13D |
| 2013-07-01 | Not in this release | Not in this release | RVU13C |
| 2013-04-01 | Not in this release | Not in this release | RVU13B |
| 2013-01-01 | Not in this release | Not in this release | RVU13AR |
Where the West Virginia rate applies
West Virginia is a Medicare payment area, not a city. Our Census mapping connects it to 439 cities and communities in West Virginia. Some span more than one payment area; confirm with the service ZIP.
- Accoville
- Addison (Webster Springs)
- Adrian
- Albright
- Alderson
- Alum Creek
- Amherstdale
- Anawalt
99151 billing questions
When should 99151 be used instead of 99152?
Use 99151 for a patient younger than five when the proceduralist provides the moderate sedation. Code 99152 is for the same-proceduralist service when the patient is five or older.
Does 99151 apply when a different clinician provides the sedation?
No. For a patient younger than five, 99155 is the corresponding initial service when a different physician or qualified health professional provides the sedation.
What time does 99151 represent?
It represents the initial 15-minute intra-service interval. Additional qualifying intra-service time may be reported with 99153.
What documentation supports reporting 99151?
Document the patient’s age, the procedure supported by sedation, the proceduralist’s role in providing sedation, the trained observer, monitoring, and intra-service start and stop times.
Is medication administration alone enough to report 99151?
No. The record should support the moderate-sedation service, including the proceduralist’s role and the observer’s monitoring assistance, rather than medication administration alone.
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
Show the CMS file lines behind this rate
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