FeeBase
Log inGet started
Menu

CPT code 99155: Moderate sedation, separate clinician, under five2026 Medicare rate & RVUs

Reports the initial moderate-sedation service for a patient younger than five when a separate physician or qualified health care professional provides the sedation.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare pays $81.50 for 99155 nationally in a facility.

Medicare rate · 99155

Moderate sedation, separate clinician, under five

Office or facility?

Work RVUs
1.9
Total RVUs
2.44
Global days
XXX

National rate · 2026

$81.50

Facility setting, before claim adjustments.

See every locality for 99155 →Billed by an NP, PA or therapist? →

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

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What 99155 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 99155 covers

This code describes the initial 15 minutes of moderate sedation for a patient younger than five, provided by a physician or qualified health care professional other than the clinician performing the procedure. The sedation clinician monitors the patient’s level of consciousness and vital signs and manages the sedation while another clinician performs a diagnostic or therapeutic service. Examples of procedures that may involve moderate sedation include endoscopy and image-guided interventions.

Report this code for the separate sedation clinician’s initial intraservice interval, not when the procedural clinician also provides the sedation. Documentation should identify the sedation clinician, the patient’s age, the procedure supported, the sedation and monitoring performed, and the intraservice time. For additional time, use the corresponding add-on code, 99157, when its requirements are met. The patient’s age and which clinician provided the sedation distinguish this code from other moderate-sedation codes.

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 99155 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

99155 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$76.77
AlaskaUnavailable$110.28
ArizonaUnavailable$80.03
ArkansasUnavailable$76.20
Atlanta, GAUnavailable$83.46
Austin, TXUnavailable$81.29
Bakersfield, CAUnavailable$80.53
Baltimore area, MDUnavailable$85.14
Beaumont, TXUnavailable$80.03
Brazoria, TXUnavailable$80.15

99155 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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.

View every state and territory as a table
99155 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 99155 rate is calculated

Each of 99155’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 · 99155

RVUs × geographic indexes × conversion factor

Office or facility?

Work1.90

1.90 RVUs× 1.000 GPCI

Practice expense0.30

0.30 RVUs× 1.000 GPCI

Malpractice0.24

0.24 RVUs× 1.000 GPCI

Adjusted RVUs

2.4400

Conversion factor

$33.4009

Medicare rate

$81.50

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 99155

99155 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 · 99155

Which rate does Medicare pay?

The POS code on the claim line (CMS-1500 box 24B).

POS 11 · non-facility rate · national

—

99155 isn’t priced in this setting.

99155 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 99155

    Moderate sedation, separate clinician, under five1.9 wRVU

    Not priced

  • 99151

    Moderate sedation, same proceduralist, under five0.5 wRVU

    $62.13

  • 99156

    Moderate sedation, other clinician, age 5+1.65 wRVU

    Not priced

  • 99157

    Moderate sedation, additional time, separate clinician1.25 wRVU

    Not priced

How to choose

99151Moderate sedationSame proceduralist, under five
Both apply to patients younger than five, but 99151 is for sedation by the procedural clinician; 99155 is for sedation by a separate clinician.
99156Moderate sedationOther clinician, age 5+
Both describe separate-clinician sedation, but 99156 is for patients age five or older; 99155 is for patients younger than five.
99157Moderate sedationAdditional time, separate clinician
99155 reports the initial 15 minutes for a patient younger than five. Code 99157 reports each qualifying additional 15-minute interval.

Codes related to 99155

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

Codes related to 99155
CodeHow it relatesNational office range
Add-on codes
99157Moderate sedation, additional time, separate clinicianAdd-on code for each additional 15 minutes of separate-clinician moderate sedation.No office rate
Same family
99156Moderate sedation, other clinician, age 5+Separate-clinician moderate sedation for a patient age five or older.No office rate
Used instead
99151Moderate sedation, same proceduralist, under fiveSedation for a patient younger than five when provided by the procedural clinician.$55.38–$83.13
99152Moderate sedation, same provider, age 5+, initial periodSedation for a patient age five or older when provided by the procedural clinician.$45.02–$70.49

99155 billing questions

When should 99155 be chosen instead of 99151?

Use 99155 when a physician or qualified health care professional other than the procedural clinician provides moderate sedation to a patient younger than five. Code 99151 describes sedation provided by the procedural clinician for a patient in that age group.

What is the age distinction between 99155 and 99156?

Both describe sedation provided by someone other than the procedural clinician. Use 99155 for a patient younger than five and 99156 for a patient age five or older.

What does the initial service include?

Code 99155 represents the initial 15 minutes of intraservice moderate sedation for a patient younger than five. Document the intraservice time and the sedation clinician’s monitoring and management.

How is additional sedation time reported?

Code 99157 is the add-on code for each additional 15 minutes when the requirements for additional intraservice time are met. It is paired with 99155 when a separate clinician provides the sedation.

Can the procedural clinician report 99155?

No. The code is for sedation provided by a physician or qualified health care professional other than the clinician performing the diagnostic or therapeutic procedure.

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
RVUs for 99155PPRRVU2026_Oct_nonQPP.csv, line 12,992 (RVU26D)

Open CMS sourceHow we calculate rates

Did this answer your question about what 99155 pays?

Tell us what you were actually trying to work out. We’ll answer you directly, or build the page that does.

Fee sheets · Coming soon

Put 99155 and the rest of your codes on one sheet

Your codes at your locality, with payer contracts beside Medicare.

Join the waitlist