CPT code 99157: Moderate sedation, additional time, separate clinician2026 Medicare rate & RVUs

Medicare pays $54.11 for 99157 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 99157 covers

99157 captures each additional 15 minutes of moderate sedation provided by a physician or qualified health care professional who is not performing the underlying procedure. A separate sedation clinician may support procedures such as an endoscopic or image-guided intervention, managing sedation and observing the patient while the proceduralist performs the service. The code represents additional sedation time, not the work of the procedure itself.

Pair 99157 with 99155 for a patient younger than 5 or 99156 for a patient age 5 or older, and report the eligible primary procedure. Select units from the documented additional sedation time. The record should identify the sedation clinician, patient age, sedation start and stop times, and the monitoring and sedation management provided. CMS classifies 99157 as an add-on code: it is billed only with a primary procedure and paid within that procedure's global period.

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 99157 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

99157 rates by state

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

How the 99157 rate is calculated

Each of 99157’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 99157

The CMS indicators that decide how 99157 is paid alongside other services.

99157 compared with similar codes

How to choose

99153Moderate sedationEach additional 15 minutes

99153 reports additional moderate sedation time when the proceduralist provides the sedation. 99157 is for additional time furnished by a different physician or qualified professional.

99155Moderate sedationSeparate clinician, under five

99155 is the initial sedation service by another clinician for a patient younger than 5. 99157 reports additional time after the applicable initial service.

99156Moderate sedationOther clinician, age 5+

99156 is the initial sedation service by another clinician for a patient age 5 or older. 99157 reports additional time after the applicable initial service.

99152Moderate sedationSame provider, age 5+, initial period

99152 is the initial service for a patient age 5 or older when the proceduralist provides sedation. 99157 applies to additional time when a different clinician provides sedation.

Codes related to 99157

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