CPT code 99152: Moderate sedation, same provider, age 5+, initial period2026 Medicare rate & RVUs

Medicare pays $51.44 for 99152 nationally in the office and $11.02 in a hospital or facility. Local office rates run $45.02–$70.49.

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

What 99152 covers

99152 covers moderate sedation directed by the physician or other qualified health care professional performing the underlying procedure for a patient age 5 or older. During a bronchoscopy, cardiac catheterization, transesophageal echocardiogram, or image-guided intervention, the proceduralist remains face-to-face with the patient while an independent trained observer, often a nurse, monitors consciousness and physiologic status. These services occur in catheterization labs, hospital procedure suites, and equipped offices.

Report 99152 once for the initial sedation period when at least 10 minutes of intraservice time are documented. Time begins when the sedating agent is administered and ends when the proceduralist’s continuous face-to-face attendance ends. Add 99153 at 23 minutes, with further units at 38 minutes and each subsequent 15-minute mark. Exclude preassessment and recovery from intraservice time; document agents, doses, the observer, monitoring, and start and stop times. For Medicare GI endoscopy with sedation directed by the endoscopist, report G0500 instead. The office practice-expense value reflects resources supplied by the practice rather than a facility.

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 99152 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

99152 rates by state

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

How the 99152 rate is calculated

Each of 99152’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 99152

99152 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.

99152 compared with similar codes

How to choose

99156Moderate sedationOther clinician, age 5+

Use 99152 when the proceduralist directs sedation. Use 99156 when a separate physician or qualified health care professional provides it for a patient age 5 or older.

99151Moderate sedationSame proceduralist, under five

Both describe initial sedation directed by the proceduralist. Use 99151 for patients younger than 5 and 99152 for patients age 5 or older.

G0500Endoscopy sedationInitial 15 minutes, age 5+

For Medicare GI endoscopy with endoscopist-directed sedation, report G0500 instead of 99152. Code 99152 can describe proceduralist-directed sedation for non-GI procedures such as bronchoscopy or cardiac catheterization.

99153Moderate sedationEach additional 15 minutes

Report 99152 once for the initial sedation period. Add the first unit of 99153 when total intraservice time reaches 23 minutes.

Codes related to 99152

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