CPT code 99415: Prolonged staff care, first hour, outpatient E/M2026 Medicare rate & RVUs

Medicare pays $23.05 for 99415 nationally in the office. Local office rates run $19.68–$32.93.

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

What 99415 covers

99415 captures prolonged, direct-contact clinical staff work during an office or other outpatient evaluation and management encounter, beyond the time ordinarily associated with that visit. Clinical staff perform the service under physician supervision; the code does not represent extra time personally spent by the physician or other qualified health care professional. It applies when staff remain engaged with the patient during an extended outpatient encounter, rather than for administrative work or unattended waiting time.

Report 99415 with the related office or outpatient E/M primary service. Document the reason for the extension and the clinical staff’s direct-contact time to support the reported service. This is an add-on, paid within the primary service’s global period, not a standalone visit. CMS classifies it as technical-component-only; any separately covered interpretation is represented by its distinct code. Use 99416 for qualifying additional prolonged clinical staff time.

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 99415 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

99415 rates by state

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

How the 99415 rate is calculated

Each of 99415’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 99415

The CMS indicators that decide how 99415 is paid alongside other services.

99415 compared with similar codes

How to choose

99416Prolonged staff serviceEach additional time unit

99415 reports the first-hour prolonged clinical staff service; 99416 reports qualifying additional prolonged staff time.

99417Prolonged E/MOffice or outpatient

99415 is for direct-contact clinical staff time during an office or outpatient E/M encounter. 99417 is for prolonged time attributable to the E/M professional.

99418Prolonged E/MInpatient or observation

99415 concerns prolonged clinical staff service in an office or outpatient E/M encounter; 99418 is the prolonged E/M service code for inpatient or observation care.

Codes related to 99415

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