CPT code 99155: Moderate sedation, separate clinician, under five2026 Medicare rate & RVUs in West Virginia
Reports the initial moderate-sedation service for a patient younger than five when a separate physician or qualified health care professional provides the sedation.
In West Virginia, Medicare pays $83.64 for 99155 in a facility. There’s no office rate.
Check a contract rate as a % of Medicare · 99155 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 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.
How West Virginia compares for 99155
Across 109 of 109 payment localities, the facility rate for 99155 runs from $75.53 in Wisconsin to $110.28 in Alaska. West Virginia pays $83.64. The RVUs are the same everywhere; the geographic indexes change the dollars.
- West Virginia · this page$83.64
- Los Angeles, CA · California$83.24−$0.40
- Washington, DC area · District of Columbia$87.61+$3.97
- Miami, FL · Florida$94.17+$10.53
- Chicago, IL · Illinois$92.37+$8.73
- Manhattan, NY · New York$91.88+$8.24
- Alaska · Alaska$110.28+$26.64
Other areas in West Virginia first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | — | $76.77 |
| ArkansasArkansas | — | $76.20 |
| ArizonaArizona | — | $80.03 |
| Bakersfield, CACalifornia | — | $80.53 |
| Chico, CACalifornia | — | $79.82 |
| El Centro, CACalifornia | — | $79.86 |
| Fresno, CACalifornia | — | $79.82 |
| Hanford, CACalifornia | — | $79.82 |
| Madera, CACalifornia | — | $79.82 |
| Merced, CACalifornia | — | $79.82 |
| Modesto, CACalifornia | — | $79.82 |
| Napa, CACalifornia | — | $84.74 |
| Oxnard, CACalifornia | — | $82.08 |
| Redding, CACalifornia | — | $79.82 |
| Rest of CaliforniaCalifornia | — | $79.82 |
| Riverside, CACalifornia | — | $82.42 |
| Sacramento, CACalifornia | — | $81.70 |
| Salinas, CACalifornia | — | $81.34 |
| San Diego, CACalifornia | — | $81.69 |
| Marin County, CACalifornia | — | $87.30 |
| San Francisco, CACalifornia | — | $87.03 |
| San Benito County, CACalifornia | — | $89.19 |
| Santa Clara County, CACalifornia | — | $88.07 |
| San Luis Obispo, CACalifornia | — | $80.25 |
| Santa Cruz, CACalifornia | — | $81.27 |
| Santa Maria, CACalifornia | — | $81.22 |
| Santa Rosa, CACalifornia | — | $81.97 |
| Stockton, CACalifornia | — | $79.82 |
| Vallejo, CACalifornia | — | $84.35 |
| Visalia, CACalifornia | — | $79.82 |
| Yuba City, CACalifornia | — | $79.82 |
| ColoradoColorado | — | $81.15 |
| ConnecticutConnecticut | — | $85.22 |
| DelawareDelaware | — | $80.89 |
| Fort Lauderdale, FLFlorida | — | $88.11 |
| Rest of FloridaFlorida | — | $85.09 |
| Atlanta, GAGeorgia | — | $83.46 |
| Rest of GeorgiaGeorgia | — | $81.96 |
| Hawaii, Guam, HIHawaii | — | $79.50 |
| IowaIowa | — | $75.81 |
| IdahoIdaho | — | $76.47 |
| East St. Louis, ILIllinois | — | $88.83 |
| Rest of IllinoisIllinois | — | $85.14 |
| Suburban Chicago, ILIllinois | — | $88.40 |
| IndianaIndiana | — | $76.65 |
| KansasKansas | — | $76.56 |
| KentuckyKentucky | — | $79.70 |
| New Orleans, LALouisiana | — | $82.00 |
| Rest of LouisianaLouisiana | — | $80.01 |
| Metropolitan Boston, MAMassachusetts | — | $85.16 |
| Rest of MassachusettsMassachusetts | — | $81.42 |
| Baltimore area, MDMaryland | — | $85.14 |
| Rest of MarylandMaryland | — | $81.60 |
| Rest of MaineMaine | — | $77.67 |
| Southern Maine, MEMaine | — | $78.45 |
| Detroit, MIMichigan | — | $86.65 |
| Rest of MichiganMichigan | — | $81.66 |
| MinnesotaMinnesota | — | $76.15 |
| Metropolitan Kansas City, MOMissouri | — | $80.70 |
| Metropolitan St. Louis, MOMissouri | — | $81.03 |
| Rest of MissouriMissouri | — | $79.91 |
| MississippiMississippi | — | $78.01 |
| MontanaMontana | — | $81.48 |
| North CarolinaNorth Carolina | — | $77.93 |
| North DakotaNorth Dakota | — | $76.74 |
| NebraskaNebraska | — | $75.74 |
| New HampshireNew Hampshire | — | $80.91 |
| Northern New JerseyNew Jersey | — | $87.64 |
| Rest of New JerseyNew Jersey | — | $85.74 |
| New MexicoNew Mexico | — | $82.28 |
| NevadaNevada | — | $80.17 |
| NYC suburbs and Long Island, NYNew York | — | $94.32 |
| Poughkeepsie and northern NYC suburbs, NYNew York | — | $86.99 |
| Queens, NYNew York | — | $90.93 |
| Rest of New YorkNew York | — | $78.62 |
| OhioOhio | — | $80.69 |
| OklahomaOklahoma | — | $78.64 |
| Portland, OROregon | — | $81.57 |
| Rest of OregonOregon | — | $79.08 |
| Metropolitan Philadelphia, PAPennsylvania | — | $84.60 |
| Rest of PennsylvaniaPennsylvania | — | $80.24 |
| Puerto RicoPuerto Rico | — | $81.49 |
| Rhode IslandRhode Island | — | $82.17 |
| South CarolinaSouth Carolina | — | $79.53 |
| South DakotaSouth Dakota | — | $76.18 |
| TennesseeTennessee | — | $76.87 |
| Austin, TXTexas | — | $81.29 |
| Beaumont, TXTexas | — | $80.03 |
| Brazoria, TXTexas | — | $80.15 |
| Dallas, TXTexas | — | $80.89 |
| Fort Worth, TXTexas | — | $80.89 |
| Galveston, TXTexas | — | $80.56 |
| Houston, TXTexas | — | $84.95 |
| Rest of TexasTexas | — | $80.21 |
| UtahUtah | — | $80.08 |
| VirginiaVirginia | — | $78.97 |
| Virgin Islands, VIUnited States Virgin Islands | — | $81.49 |
| VermontVermont | — | $77.44 |
| Rest of WashingtonWashington | — | $80.94 |
| King County, WAWashington | — | $85.48 |
| WisconsinWisconsin | — | $75.53 |
| WyomingWyoming | — | $79.41 |
99155 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.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
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.
The exact West Virginia inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
12,992
- Code
- 99155
- Physician work
- 1.90
- Practice expense
- 0.30
- Malpractice
- 0.24
GPCI2026.csv
110
- Locality
- West Virginia
- Physician work
- 1.000
- Practice expense
- 0.869
- Malpractice
- 1.431
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.90 | × 1.000 | 1.9000 |
| Practice expense | 0.30 | × 0.869 | 0.2607 |
| Malpractice | 0.24 | × 1.431 | 0.3434 |
| Total RVUs | 2.5041 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, West Virginia$83.64
Facility: (1.9 × 1 + 0.3 × 0.869 + 0.24 × 1.431) × $33.4009 = $83.64
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.
How 99155 has changed in West Virginia
99155 · Office / nonfacility
Rate unavailable
Effective 2026-10-01
A rate is unavailable in one of these releases, so a change cannot be calculated.
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, 2017
RVU17A
No ratechanged toNo rate
Held through RVU17B, RVU17C, RVU17D, RVU18AR1, RVU18B, RVU18C, RVU18D, RVU19A, RVU19B, RVU19C, RVU19D, RVU20A, RVU20B, RVU20C, RVU20D, RVU21A, RVU21B, RVU21C, RVU21D, RVU22A, RVU22B, RVU22C, RVU22D, RVU23A, RVU23B, RVU23C, RVU23D, RVU24A, RVU24AR, RVU24B, RVU24C, RVU24D, RVU25A, RVU25B, RVU25C, RVU25D, RVU26A, RVU26B, RVU26C, RVU26D.
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 | Not available in this setting | $83.64 | RVU26D |
| 2026-07-01 | Not available in this setting | $83.64 | RVU26C |
| 2026-04-01 | Not available in this setting | $83.64 | RVU26B |
| 2026-01-01 | Not available in this setting | $83.64 | RVU26A |
| 2025-10-01 | Not available in this setting | $80.27 | RVU25D |
| 2025-07-01 | Not available in this setting | $80.27 | RVU25C |
| 2025-04-01 | Not available in this setting | $80.27 | RVU25B |
| 2025-01-01 | Not available in this setting | $80.27 | RVU25A |
| 2024-10-01 | Not available in this setting | $82.32 | RVU24D |
| 2024-07-01 | Not available in this setting | $82.32 | RVU24C |
| 2024-04-01 | Not available in this setting | $82.32 | RVU24B |
| 2024-03-09 | Not available in this setting | $82.32 | RVU24AR |
| 2024-01-01 | Not available in this setting | $80.98 | RVU24A |
| 2023-10-01 | Not available in this setting | $82.87 | RVU23D |
| 2023-07-01 | Not available in this setting | $82.87 | RVU23C |
| 2023-04-01 | Not available in this setting | $82.87 | RVU23B |
| 2023-01-01 | Not available in this setting | $82.87 | RVU23A |
| 2022-10-01 | Not available in this setting | $83.96 | RVU22D |
| 2022-07-01 | Not available in this setting | $83.96 | RVU22C |
| 2022-04-01 | Not available in this setting | $83.96 | RVU22B |
| 2022-01-01 | Not available in this setting | $83.96 | RVU22A |
| 2021-10-01 | Not available in this setting | $84.66 | RVU21D |
| 2021-07-01 | Not available in this setting | $84.66 | RVU21C |
| 2021-04-01 | Not available in this setting | $84.66 | RVU21B |
| 2021-01-01 | Not available in this setting | $84.66 | RVU21A |
| 2020-10-01 | Not available in this setting | $87.92 | RVU20D |
| 2020-07-01 | Not available in this setting | $87.92 | RVU20C |
| 2020-04-01 | Not available in this setting | $87.92 | RVU20B |
| 2020-01-01 | Not available in this setting | $87.92 | RVU20A |
| 2019-10-01 | Not available in this setting | $91.09 | RVU19D |
| 2019-07-01 | Not available in this setting | $91.09 | RVU19C |
| 2019-04-01 | Not available in this setting | $91.09 | RVU19B |
| 2019-01-01 | Not available in this setting | $91.09 | RVU19A |
| 2018-10-01 | Not available in this setting | $96.53 | RVU18D |
| 2018-07-01 | Not available in this setting | $96.53 | RVU18C |
| 2018-04-01 | Not available in this setting | $96.53 | RVU18B |
| 2018-01-01 | Not available in this setting | $96.53 | RVU18AR1 |
| 2017-10-01 | Not available in this setting | $93.08 | RVU17D |
| 2017-07-01 | Not available in this setting | $93.08 | RVU17C |
| 2017-04-01 | Not available in this setting | $93.08 | RVU17B |
| 2017-01-01 | Not available in this setting | $93.08 | 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
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
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