CPT code 99195: Therapeutic phlebotomy, therapeutic blood removal2026 Medicare rate & RVUs in Michigan
Report therapeutic phlebotomy when blood is removed as treatment, such as for hemochromatosis or polycythemia, rather than collected only for testing.
Medicare pays $90.02–$95.97 for 99195 in the office in Michigan, from Rest of Michigan to Detroit, MI. Which amount applies depends on the service address.
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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On this page 9 sections
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 in Michigan
| Payment locality | Office | Facility |
|---|---|---|
| Detroit, MI | $95.97 | Unavailable |
| Rest of Michigan | $90.02 | Unavailable |
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.
How the rate is built · 99195
RVUs × geographic indexes × conversion factor
Work0.00
0.00 RVUs× 1.000 GPCI
Practice expense2.89
2.89 RVUs× 1.000 GPCI
Malpractice0.05
0.05 RVUs× 1.000 GPCI
Adjusted RVUs
2.9400
Conversion factor
$33.4009
Medicare rate
$98.20
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 99195
The CMS indicators that decide how 99195 is paid alongside other services.
CMS payment indicators · 99195
Therapeutic phlebotomy, therapeutic blood removal
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 5 | Incident-to service. |
99195 compared with similar codes
Compare codes · National
99195 vs 36415 vs 85025: Medicare rates
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.
99195 billing questions
How is 99195 different from 36415?
99195 represents blood removal as treatment, such as for hemochromatosis or polycythemia. Code 36415 represents routine venous blood collection for testing.
Can a CBC or hematocrit be reported with 99195?
A CBC or hematocrit may be separately reported when the test is performed as a distinct service, such as monitoring blood counts. The test result alone does not establish that therapeutic phlebotomy was performed.
What documentation supports reporting 99195?
Document the therapeutic indication and that blood was removed as treatment. Including the amount removed helps describe the procedure performed.
Who may perform the procedure for Medicare billing?
The service is billed as incident-to and, when performed by staff, requires physician supervision.
Is 99195 reported for each tube collected?
No. The code represents therapeutic blood removal, not the number of diagnostic specimen tubes.
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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