CPT code 99153: Moderate sedation2026 Medicare rate & RVUs

Medicare pays $12.36 for 99153 nationally in the office. Local office rates run $10.39–$17.22.

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

What 99153 covers

Code 99153 represents additional intraservice time for moderate sedation provided by the physician or qualified health care professional performing the procedure that requires sedation. It may be relevant during services such as endoscopy, cardiac catheterization, or image-guided intervention when the procedural clinician provides the sedation and a trained observer assists with monitoring the patient’s level of consciousness and physiological status. Count the time spent providing the sedation service, not recovery time.

Report 99153 only with the related primary procedure and the appropriate initial same-provider sedation code, 99151 or 99152. Documentation should identify who performed the procedure and sedation, the observer, the patient’s monitored status, and the intraservice time supporting each additional unit. CMS treats this as an add-on code paid within the primary procedure’s global period. It is technical-component-only; a separate code covers interpretation.

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 99153 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

99153 rates by state

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

How the 99153 rate is calculated

Each of 99153’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 99153

The CMS indicators that decide how 99153 is paid alongside other services.

99153 compared with similar codes

How to choose

99151Moderate sedation

99151 reports the initial same-provider sedation service for a patient younger than 5 years; 99153 reports additional time after the initial service.

99152Moderate sedation

99152 reports the initial same-provider sedation service for a patient age 5 or older. Use 99153 for additional time, not as a substitute for the initial code.

99157Moderate sedation

99153 applies when the procedural clinician provides the sedation; 99157 applies to additional time when a different physician or qualified health care professional provides it.

Codes related to 99153

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