CPT code 99155: Moderate sedation, separate clinician, under five2026 Medicare rate & RVUs in Georgia
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 doesn’t publish an office rate for 99155 in Georgia.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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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 in Georgia
| Payment locality | Office | Facility |
|---|---|---|
| Atlanta, GA | Unavailable | $83.46 |
| Rest of Georgia | Unavailable | $81.96 |
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
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
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99155 isn’t priced in this setting.
99155 compared with similar codes
Compare codes · National
4 codes, side by side
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.
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
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