CPT code 99156: Moderate sedation, other clinician, age 5+2026 Medicare rate & RVUs

Medicare pays $71.14 for 99156 nationally in a facility.

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

What 99156 covers

99156 represents a physician’s or qualified health care professional’s work to provide moderate sedation for a patient aged 5 or older while another clinician performs the diagnostic or therapeutic procedure. A common setting is an image-guided intervention in which a separate clinician manages sedation and monitors the patient. The sedation clinician’s service includes intraservice care, with a trained observer assisting with monitoring.

Report one unit for the initial 15 minutes of intraservice time, supported by documentation identifying the sedation clinician and recording the time, medications, patient response, and monitoring. Do not include preparation or recovery time in the intraservice time. Report 99157 with 99156 for qualifying additional time. Use 99152 when the same physician or qualified professional provides sedation and performs the procedure, or 99155 when a separate clinician provides sedation to a child younger than 5.

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 99156 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

99156 rates by state

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

How the 99156 rate is calculated

Each of 99156’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 99156

99156 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.

99156 compared with similar codes

How to choose

99152Moderate sedationSame provider, age 5+, initial period

Choose 99152 when the clinician providing moderate sedation also performs the procedure. Choose 99156 when those roles are performed by different clinicians and the patient is aged 5 or older.

99155Moderate sedationSeparate clinician, under five

99155 is for separate-clinician moderate sedation for a child younger than 5. 99156 is for the same provider arrangement when the patient is aged 5 or older.

99157Moderate sedationAdditional time, separate clinician

99157 reports qualifying additional intraservice time with 99156; it does not represent the initial sedation service.

99153Moderate sedationEach additional 15 minutes

99153 reports qualifying additional time when the proceduralist provides the sedation. Use 99157 for additional time when a different clinician provides it.

Codes related to 99156

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