CPT code 99157: Moderate sedation, additional time, separate clinician2026 Medicare rate & RVUs in New York
Report 99157 for each additional 15 minutes of moderate sedation furnished by a physician or qualified professional other than the proceduralist.
CMS doesn’t publish an office rate for 99157 in New York.
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 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 in New York
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Manhattan, NY | Unavailable | $60.77 |
| NYC suburbs and Long Island, NY | Unavailable | $62.24 |
| Poughkeepsie and northern NYC suburbs, NY | Unavailable | $57.70 |
| Queens, NY | Unavailable | $60.25 |
| Rest of New York | Unavailable | $52.34 |
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.
How the rate is built · 99157
RVUs × geographic indexes × conversion factor
Work1.25
1.25 RVUs× 1.000 GPCI
Practice expense0.23
0.23 RVUs× 1.000 GPCI
Malpractice0.14
0.14 RVUs× 1.000 GPCI
Adjusted RVUs
1.6200
Conversion factor
$33.4009
Medicare rate
$54.11
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 99157
The CMS indicators that decide how 99157 is paid alongside other services.
CMS payment indicators · 99157
Moderate sedation, additional time, separate clinician
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 9 | The concept doesn’t apply. |
| Bilateral (modifier 50) | 9 | The concept doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 9 | The concept doesn’t apply. |
| Co-surgeons (62) | 9 | The concept doesn’t apply. |
| Team surgery (66) | 9 | The concept doesn’t apply. |
| Professional/technical | 9 | The concept doesn’t apply. |
99157 compared with similar codes
Compare codes · National
5 codes, side by side
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.
99157 billing questions
Which initial sedation code accompanies 99157?
Use 99155 when the patient is younger than 5 and 99156 when the patient is age 5 or older. The sedation clinician must be different from the clinician performing the procedure.
Can 99157 be reported by itself?
No. It is an add-on code and must be reported with the primary procedure and the applicable initial sedation service.
How many units should be reported?
Report units based on documented additional 15-minute periods of moderate sedation. The record should support the actual sedation time and the clinician who furnished it.
Does 99157 apply when the proceduralist provides the sedation?
No. When the same physician or qualified professional performs the procedure and provides sedation, the applicable additional-time code is 99153.
What documentation supports 99157?
Document the patient's age, the separate sedation clinician, start and stop times, and the sedation management and patient observation provided.
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.
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