99172
No office rateOcular function screen
99172 represents ocular function screening. It is not the magnified child anogenital examination with specimen collection reported by 99170.
On this page
CMS RVU26D · Effective 2026-10-01
99170 Anogenital exam Medicare reimbursement rates in Connecticut
Reports a magnified anogenital examination of a child when the clinician also collects specimens for cytology or culture. Compare 99170 office and facility rates across CMS payment localities in Connecticut.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 99170 in Connecticut?
Connecticut has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$176.29
1 of 1 localities have a supported rate.
Payment area: Connecticut
One mapped payment locality.
Facility setting
$74.49
1 of 1 localities have a supported rate.
Payment area: Connecticut
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Special diagnostic services
About 99170: Magnified child anogenital examination
Reports a magnified anogenital examination of a child when the clinician also collects specimens for cytology or culture.
This service is a focused examination of a child’s anogenital area using magnification, such as colposcopic equipment, with collection of specimens for cytologic examination or culture. It is typically performed by a clinician experienced in pediatric anogenital assessment, such as a child-abuse pediatrician or pediatric gynecologist. Clinical situations may include evaluation of suspected abuse, injury, or infection; specimens may include anogenital swabs when testing is indicated.
Select the code when both the magnified examination and specimen collection are documented; record the reason for the assessment, examination findings, and specimens collected. CMS assigns physician work, practice-expense, and malpractice relative values, with different practice-expense inputs for office and facility settings. The 0-day global period includes same-day preoperative and postoperative care. In a same-session multiple-procedure situation, the highest-valued procedure is paid in full and the others at 50%. Modifier 50 is inappropriate. Medicare does not pay an assistant at surgery for this service, and co-surgeons and team surgery are not permitted. CMS recorded no Medicare services in office or facility settings in 2024.
CMS billing rules for 99170
- Global period
- Minor procedure with a 0-day global period: same-day preoperative and postoperative care is included.
- Multiple procedures
- Standard multiple procedure reduction: the highest-valued procedure is paid in full and others at 50% when performed in the same session.
- Bilateral procedures
- Bilateral adjustment does not apply; the descriptor or anatomy makes modifier 50 inappropriate.
- Assistant at surgery
- Statutory restriction: assistant at surgery is not paid.
- Co-surgeons
- Co-surgeons not permitted.
- Team surgery
- Team surgery not permitted.
Where the value comes from
- Work RVU1.71 · 34%
- Practice expense (office) RVU3.18 · 64%
- Malpractice RVU0.09 · 2%
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.
99170 compared with similar codes
Office rates for Connecticut, from the same CMS release.
99173
No office rateVisual acuity screen
99173 is a visual acuity screening service; 99170 concerns a child’s anogenital examination and specimen collection.
$79.48
99202 is a new-patient office E/M service selected by its E/M requirements. It does not replace the specific magnified examination and specimen collection represented by 99170.
Compare 99170 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Connecticut →
Office / nonfacility
$176.29
Facility
$74.49
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 99170 in Connecticut.
PPRRVU2026_Oct_nonQPP.csv
12,995
- Code
- 99170
- Physician work
- 1.71
- Practice expense
- 3.18
- Malpractice
- 0.09
GPCI2026.csv
38
- Locality
- Connecticut
- Physician work
- 1.020
- Practice expense
- 1.077
- Malpractice
- 1.210
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.71 | × 1.020 | 1.7442 |
| Practice expense | 3.18 | × 1.077 | 3.4249 |
| Malpractice | 0.09 | × 1.210 | 0.1089 |
| Total RVUs | 5.2780 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Connecticut$176.29
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.71 | 1.02 |
| Practice expense | 3.18 | 1.077 |
| Malpractice | 0.09 | 1.21 |
(1.71 × 1.02 + 3.18 × 1.077 + 0.09 × 1.21) × $33.4009 = $176.29
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.71 | 1.02 |
| Practice expense | 0.35 | 1.077 |
| Malpractice | 0.09 | 1.21 |
(1.71 × 1.02 + 0.35 × 1.077 + 0.09 × 1.21) × $33.4009 = $74.49
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
99170 billing questions
Does 99170 include the laboratory analysis?
The service includes collecting specimens for cytology or culture. Report the test-specific laboratory service when testing is performed and separately reportable.
When should this be chosen instead of a standard office visit?
Use 99170 for the magnified child anogenital examination with specimen collection. A standard office E/M code represents qualifying evaluation and management work, not a substitute for this specific service.
Can modifier 50 be used for examination of both sides?
No. CMS identifies bilateral adjustment as inappropriate for this code.
How does the multiple-procedure reduction work?
For procedures performed in the same session, CMS pays the highest-valued procedure in full and the other procedures at 50%.
Does the 0-day global period include same-day follow-up care?
Same-day preoperative and postoperative care is included in the 0-day global period.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
12,99299155,,Mod sed oth phys/qhp <5 yrs,A,,1.90,0.30,NA,0.30,,0.24,2.44,2.44,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
12,99399156,,Mod sed oth phys/qhp 5/>yrs,A,,1.65,0.29,NA,0.29,,0.19,2.13,2.13,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
12,99499157,,Mod sed other phys/qhp ea,A,,1.25,0.23,NA,0.23,,0.14,1.62,1.62,9,ZZZ,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
12,99599170,,Anogenital exam child w imag,A,,1.71,3.18,,0.35,,0.09,4.98,2.15,0,000,0.00,0.00,0.00,2,0,1,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
12,99699172,,Ocular function screen,N,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
12,99799173,,Visual acuity screen,N,+,0.00,0.09,,0.09,NA,0.01,0.10,0.10,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
12,99899174,,Ocular instrumnt screen bil,N,+,0.00,0.19,,0.19,NA,0.01,0.20,0.20,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
3501112,CA,70,YUBA CITY,1.017,1.096,0.536
3601112,CA,75,REST OF CALIFORNIA,1.017,1.096,0.536
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899
4109102,FL,03,FORT LAUDERDALE,1.000,1.013,1.808