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Billing code 99157: Moderate sedationMedicare rate & RVUs

Report 99157 for each additional 15 minutes of moderate sedation furnished by a physician or qualified professional other than the proceduralist.

CMS RVU26DEffective Oct 1, 2026109 payment localities5.4K Medicare services in 2024

Medicare pays $54.11 for 99157 nationally in a facility.

Medicare rate · 99157

Moderate sedation

Swap in your local Medicare rate.

Work RVUs
1.25
Total RVUs
1.62
Global days
ZZZ

National rate · 2026

$54.11

Facility setting, before claim adjustments.

See every locality for 99157 → · Billed by an NP, PA or therapist? →

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

On this page 10 sections
  1. Medicare rate
  2. What 99157 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

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

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

99157 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$51.12
Alaska*Unavailable$73.38
ArizonaUnavailable$53.20
ArkansasUnavailable$50.76
AtlantaUnavailable$55.30
AustinUnavailable$54.11
BakersfieldUnavailable$53.81
Baltimore/Surr. CntysUnavailable$56.45
BeaumontUnavailable$53.09
BrazoriaUnavailable$53.35

99157 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

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Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
99157 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

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

Swap in your local Medicare rate.

Work 1.25Practice expense 0.23Malpractice 0.14

1.6200 adjusted RVUs×$33.4009 conversion factor=$54.11

All indexes start 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

RuleCMS valueWhat it means
Global periodZZZAdd-on code: falls within the primary procedure’s global period.
Multiple procedures9The concept doesn’t apply.
Bilateral (modifier 50)9The concept doesn’t apply.
Assistant at surgery (80/81/82/AS)9The concept doesn’t apply.
Co-surgeons (62)9The concept doesn’t apply.
Team surgery (66)9The concept doesn’t apply.
Professional/technical9The concept doesn’t apply.

99157 compared with similar codes

Compare codes

99157 vs 99153 vs 99155 vs 99156 vs 99152: national Medicare rates

Swap in your local Medicare rate.

  • 99157
    Moderate sedation · 1.25 wRVU
    —
  • 99153
    Moderate sedation · 0 wRVU
    $12.36
  • 99155
    Moderate sedation · 1.9 wRVU
    —
  • 99156
    Moderate sedation · 1.65 wRVU
    —
  • 99152
    Moderate sedation · 0.25 wRVU
    $51.44

How to choose

99153Moderate sedation
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 sedation
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 sedation
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 sedation
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.

Codes related to 99157

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 99157
CodeHow it relatesNational office range
Primary code
99155Moderate sedationInitial moderate sedation by another clinician for a patient younger than 5.No office rate
99156Moderate sedationInitial moderate sedation by another clinician for a patient age 5 or older.No office rate
Used instead
99153Moderate sedationAdditional sedation time when the proceduralist also provides the sedation.$10.39–$17.22
99151Moderate sedationInitial sedation when the proceduralist provides it for a patient younger than 5.$55.38–$83.13
99152Moderate sedationInitial sedation when the proceduralist provides it for a patient age 5 or older.$45.02–$70.49

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.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Show the CMS file lines behind this rate
RVUs for 99157PPRRVU2026_Oct_nonQPP.csv, line 12,994 (RVU26D)

Open CMS sourceHow we calculate rates

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