$12.15
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.
On this page
CMS RVU26D · Effective 2026-10-01
99157 Moderate sedation Medicare reimbursement rates in Delaware
Report 99157 for each additional 15 minutes of moderate sedation furnished by a physician or qualified professional other than the proceduralist. Compare 99157 office and facility rates across CMS payment localities in Delaware.
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 99157 in Delaware?
Delaware 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
No supported rate
Facility setting
$53.75
1 of 1 localities have a supported rate.
Payment area: Delaware
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.
Moderate sedation
About 99157: Additional moderate sedation time by another clinician
Report 99157 for each additional 15 minutes of moderate sedation furnished by a physician or qualified professional other than the proceduralist.
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.
CMS billing rules for 99157
- Global period
- Add-on code: billed only together with a primary procedure and paid within that procedure's global period.
Where the value comes from
- Work RVU1.25 · 77%
- Practice expense (office) RVU0.23 · 14%
- Malpractice RVU0.14 · 9%
5.4K
Medicare services in 2024 · #1826 by national volume
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.
99157 compared with similar codes
Office rates for Delaware, from the same CMS release.
No office rate
99155 is the initial sedation service by another clinician for a patient younger than 5. 99157 reports additional time after the applicable initial service.
No office rate
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.
$50.87
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.
Compare 99157 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
Delaware →
Office / nonfacility
Unavailable
Facility
$53.75
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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 99157 in Delaware.
PPRRVU2026_Oct_nonQPP.csv
12,994
- Code
- 99157
- Physician work
- 1.25
- Practice expense
- 0.23
- Malpractice
- 0.14
GPCI2026.csv
40
- Locality
- Delaware
- Physician work
- 1.005
- Practice expense
- 0.988
- Malpractice
- 0.899
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.25 | × 1.005 | 1.2562 |
| Practice expense | 0.23 | × 0.988 | 0.2272 |
| Malpractice | 0.14 | × 0.899 | 0.1259 |
| Total RVUs | 1.6093 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Delaware$53.75
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.25 | 1.005 |
| Practice expense | 0.23 | 0.988 |
| Malpractice | 0.14 | 0.899 |
(1.25 × 1.005 + 0.23 × 0.988 + 0.14 × 0.899) × $33.4009 = $53.75
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.
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 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.
12,99199153,,Mod sed same phys/qhp ea,A,,0.00,0.35,,0.35,NA,0.02,0.37,0.37,3,ZZZ,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
12,99299155,,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
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
4209102,FL,04,MIAMI,1.000,1.041,2.529
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503