CPT code 99195: Therapeutic phlebotomy, therapeutic blood removal2026 Medicare rate & RVUs

Medicare pays $98.20 for 99195 nationally in the office. Local office rates run $83.78–$140.09.

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

What 99195 covers

CPT 99195 represents blood removal for a therapeutic purpose, such as reducing iron stores in a patient with hemochromatosis or lowering red cell mass in a patient with polycythemia. It is distinct from drawing a sample for laboratory analysis. A physician or office staff member may perform the procedure in an outpatient setting; when staff perform it, Medicare treats the service as incident-to and requires physician supervision for billing.

Document the treatment indication and that therapeutic blood removal was performed; recording the amount removed helps show the service provided. Report 99195 for the therapeutic procedure, not for each specimen tube or laboratory test. A CBC or hematocrit may be reported separately when performed as a distinct test. Medicare payment requires physician supervision when the service is performed incident-to.

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 99195 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

99195 rates by state

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

How the 99195 rate is calculated

Each of 99195’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 99195

The CMS indicators that decide how 99195 is paid alongside other services.

99195 compared with similar codes

How to choose

36415VenipunctureRoutine venous sample

Use 36415 for routine venous blood collection to obtain a laboratory specimen. Use 99195 when blood removal itself is the treatment.

85025Complete CBCAutomated differential

Code 85025 reports a blood count with an automated differential, not the therapeutic removal of blood. It may be reported separately when that test is performed.

Codes related to 99195

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