No office rate
Use 99152 when the proceduralist directs sedation. Use 99156 when a separate physician or qualified health care professional provides it for a patient age 5 or older.
On this page
CMS RVU26D · Effective 2026-10-01
99152 Moderate sedation Medicare reimbursement rates in Kentucky
Report initial moderate sedation for a patient age 5 or older when the procedure provider directs it with an independent trained observer. Compare 99152 office and facility rates across CMS payment localities in Kentucky.
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 99152 in Kentucky?
Kentucky 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
$46.68
1 of 1 localities have a supported rate.
Payment area: Kentucky
One mapped payment locality.
Facility setting
$10.75
1 of 1 localities have a supported rate.
Payment area: Kentucky
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 99152: Moderate sedation by proceduralist, age 5 or older
Report initial moderate sedation for a patient age 5 or older when the procedure provider directs it with an independent trained observer.
99152 covers moderate sedation directed by the physician or other qualified health care professional performing the underlying procedure for a patient age 5 or older. During a bronchoscopy, cardiac catheterization, transesophageal echocardiogram, or image-guided intervention, the proceduralist remains face-to-face with the patient while an independent trained observer, often a nurse, monitors consciousness and physiologic status. These services occur in catheterization labs, hospital procedure suites, and equipped offices.
Report 99152 once for the initial sedation period when at least 10 minutes of intraservice time are documented. Time begins when the sedating agent is administered and ends when the proceduralist’s continuous face-to-face attendance ends. Add 99153 at 23 minutes, with further units at 38 minutes and each subsequent 15-minute mark. Exclude preassessment and recovery from intraservice time; document agents, doses, the observer, monitoring, and start and stop times. For Medicare GI endoscopy with sedation directed by the endoscopist, report G0500 instead. The office practice-expense value reflects resources supplied by the practice rather than a facility.
Where the value comes from
- Work RVU0.25 · 16%
- Practice expense (office) RVU1.26 · 82%
- Malpractice RVU0.03 · 2%
1.4M
Medicare services in 2024 · #113 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.
99152 compared with similar codes
Office rates for Kentucky, from the same CMS release.
$57.11
Both describe initial sedation directed by the proceduralist. Use 99151 for patients younger than 5 and 99152 for patients age 5 or older.
$59.49
For Medicare GI endoscopy with endoscopist-directed sedation, report G0500 instead of 99152. Code 99152 can describe proceduralist-directed sedation for non-GI procedures such as bronchoscopy or cardiac catheterization.
$11.00
Report 99152 once for the initial sedation period. Add the first unit of 99153 when total intraservice time reaches 23 minutes.
Compare 99152 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
Kentucky →
Office / nonfacility
$46.68
Facility
$10.75
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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 99152 in Kentucky.
PPRRVU2026_Oct_nonQPP.csv
12,990
- Code
- 99152
- Physician work
- 0.25
- Practice expense
- 1.26
- Malpractice
- 0.03
GPCI2026.csv
55
- Locality
- Kentucky
- Physician work
- 1.000
- Practice expense
- 0.889
- Malpractice
- 0.915
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.25 | × 1.000 | 0.2500 |
| Practice expense | 1.26 | × 0.889 | 1.1201 |
| Malpractice | 0.03 | × 0.915 | 0.0274 |
| Total RVUs | 1.3976 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Kentucky$46.68
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.25 | 1 |
| Practice expense | 1.26 | 0.889 |
| Malpractice | 0.03 | 0.915 |
(0.25 × 1 + 1.26 × 0.889 + 0.03 × 0.915) × $33.4009 = $46.68
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 0.25 | 1 |
| Practice expense | 0.05 | 0.889 |
| Malpractice | 0.03 | 0.915 |
(0.25 × 1 + 0.05 × 0.889 + 0.03 × 0.915) × $33.4009 = $10.75
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.
99152 billing questions
What is the minimum time needed to report 99152?
At least 10 minutes of intraservice time is required. Sedation lasting under 10 minutes is not reported separately.
When is 99153 added?
Report one unit of 99153 when total intraservice time reaches 23 minutes. Additional units begin at 38 minutes, 53 minutes, and each subsequent 15-minute mark.
Can 99152 be billed if no independent observer is present?
No. This code requires a trained observer to monitor the patient while the proceduralist directs sedation and performs the procedure.
How does this differ from sedation provided by a separate clinician?
For a patient age 5 or older, a separate physician or qualified health care professional providing sedation reports 99156, adding 99157 only when the time warrants it. For a younger patient, the separate-provider initial code is 99155.
Should 99152 be used with a Medicare screening or diagnostic colonoscopy?
No. When the endoscopist provides moderate sedation for Medicare GI endoscopy to a patient age 5 or older, report G0500 instead of 99152.
Does the presedation evaluation count toward sedation time?
No. Presedation assessment, consent, and recovery monitoring after the proceduralist’s face-to-face attendance ends are excluded from intraservice time.
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.
12,98799135,,Anes comp ctrld hypotension,B,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,ZZZ,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
12,98899140,,Anes comp emergency cond,B,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,ZZZ,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
12,98999151,,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
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
5707202,LA,99,REST OF LOUISIANA,1.000,0.885,0.958
5814112,ME,03,SOUTHERN MAINE,1.000,0.991,0.631