$57.75
Both apply to patients younger than five, but 99151 is for sedation by the procedural clinician; 99155 is for sedation by a separate clinician.
On this page
CMS RVU26D · Effective 2026-10-01
99155 Moderate sedation Medicare reimbursement rates in Iowa
Reports the initial moderate-sedation service for a patient younger than five when a separate physician or qualified health care professional provides the sedation. Compare 99155 office and facility rates across CMS payment localities in Iowa.
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 99155 in Iowa?
Iowa 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
$75.81
1 of 1 localities have a supported rate.
Payment area: Iowa
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 99155: Moderate sedation by separate clinician, child under five
Reports the initial moderate-sedation service for a patient younger than five when a separate physician or qualified health care professional provides the sedation.
This code describes the initial 15 minutes of moderate sedation for a patient younger than five, provided by a physician or qualified health care professional other than the clinician performing the procedure. The sedation clinician monitors the patient’s level of consciousness and vital signs and manages the sedation while another clinician performs a diagnostic or therapeutic service. Examples of procedures that may involve moderate sedation include endoscopy and image-guided interventions.
Report this code for the separate sedation clinician’s initial intraservice interval, not when the procedural clinician also provides the sedation. Documentation should identify the sedation clinician, the patient’s age, the procedure supported, the sedation and monitoring performed, and the intraservice time. For additional time, use the corresponding add-on code, 99157, when its requirements are met. The patient’s age and which clinician provided the sedation distinguish this code from other moderate-sedation codes.
Where the value comes from
- Work RVU1.90 · 78%
- Practice expense (office) RVU0.30 · 12%
- Malpractice RVU0.24 · 10%
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.
99155 compared with similar codes
Office rates for Iowa, from the same CMS release.
No office rate
Both describe separate-clinician sedation, but 99156 is for patients age five or older; 99155 is for patients younger than five.
No office rate
99155 reports the initial 15 minutes for a patient younger than five. Code 99157 reports each qualifying additional 15-minute interval.
Compare 99155 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
Iowa →
Office / nonfacility
Unavailable
Facility
$75.81
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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 99155 in Iowa.
PPRRVU2026_Oct_nonQPP.csv
12,992
- Code
- 99155
- Physician work
- 1.90
- Practice expense
- 0.30
- Malpractice
- 0.24
GPCI2026.csv
53
- Locality
- Iowa
- Physician work
- 1.000
- Practice expense
- 0.915
- Malpractice
- 0.397
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.90 | × 1.000 | 1.9000 |
| Practice expense | 0.30 | × 0.915 | 0.2745 |
| Malpractice | 0.24 | × 0.397 | 0.0953 |
| Total RVUs | 2.2698 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Iowa$75.81
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1.9 | 1 |
| Practice expense | 0.3 | 0.915 |
| Malpractice | 0.24 | 0.397 |
(1.9 × 1 + 0.3 × 0.915 + 0.24 × 0.397) × $33.4009 = $75.81
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.
99155 billing questions
When should 99155 be chosen instead of 99151?
Use 99155 when a physician or qualified health care professional other than the procedural clinician provides moderate sedation to a patient younger than five. Code 99151 describes sedation provided by the procedural clinician for a patient in that age group.
What is the age distinction between 99155 and 99156?
Both describe sedation provided by someone other than the procedural clinician. Use 99155 for a patient younger than five and 99156 for a patient age five or older.
What does the initial service include?
Code 99155 represents the initial 15 minutes of intraservice moderate sedation for a patient younger than five. Document the intraservice time and the sedation clinician’s monitoring and management.
How is additional sedation time reported?
Code 99157 is the add-on code for each additional 15 minutes when the requirements for additional intraservice time are met. It is paired with 99155 when a separate clinician provides the sedation.
Can the procedural clinician report 99155?
No. The code is for sedation provided by a physician or qualified health care professional other than the clinician performing the diagnostic or therapeutic procedure.
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.
12,98999151,,Mod sed same phys/qhp <5 yrs,A,,0.50,1.33,,0.10,,0.03,1.86,0.63,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
12,99099152,,Mod sed same phys/qhp 5/>yrs,A,,0.25,1.26,,0.05,,0.03,1.54,0.33,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
12,99199153,,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
5006102,IL,15,SUBURBAN CHICAGO,1.007,1.027,1.772
5106102,IL,99,REST OF ILLINOIS,1.000,0.913,1.563
5208102,IN,00,INDIANA,1.000,0.927,0.486
5305102,IA,00,IOWA,1.000,0.915,0.397
5405202,KS,00,KANSAS,1.000,0.904,0.504
5515102,KY,00,KENTUCKY,1.000,0.889,0.915
5607202,LA,01,NEW ORLEANS,1.000,0.941,1.136