CPT code 99156: Moderate sedation, other clinician, age 5+2026 Medicare rate & RVUs in Washington
Reports the initial moderate-sedation service for a patient aged 5 or older when a physician or qualified professional other than the proceduralist provides sedation.
CMS doesn’t publish an office rate for 99156 in Washington.
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 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 in Washington
| Payment locality | Office | Facility |
|---|---|---|
| King County, WA | Unavailable | $74.94 |
| Rest of Washington | Unavailable | $70.86 |
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.
How the rate is built · 99156
RVUs × geographic indexes × conversion factor
Work1.65
1.65 RVUs× 1.000 GPCI
Practice expense0.29
0.29 RVUs× 1.000 GPCI
Malpractice0.19
0.19 RVUs× 1.000 GPCI
Adjusted RVUs
2.1300
Conversion factor
$33.4009
Medicare rate
$71.14
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
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.
Place of service · 99156
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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99156 isn’t priced in this setting.
99156 compared with similar codes
Compare codes · National
5 codes, side by side
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.
99156 billing questions
How is 99156 different from 99152?
Use 99156 when a physician or qualified professional other than the proceduralist provides the moderate sedation. Use 99152 when the same clinician performs the procedure and provides sedation.
What service is reported with 99157?
99157 reports qualifying additional intraservice time beyond the initial period represented by 99156. It is an add-on code reported with 99156, not by itself.
Which time should the record support?
Document the sedation clinician’s intraservice time, along with the medications, monitoring, and patient response. Preparation and recovery time are not part of that intraservice time.
When does age change the code?
For a patient aged 5 or older, use 99156 when a separate physician or qualified professional provides sedation. For a child younger than 5 in that same provider arrangement, use 99155.
What documentation distinguishes this from sedation by the proceduralist?
Identify the clinician who provided sedation and the clinician who performed the procedure. The record should make clear that they were different clinicians and support the sedation service and its intraservice time.
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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