Billing code 99151: Moderate sedationMedicare rate & RVUs in Missouri
Moderate sedation performed by the procedure’s physician or qualified health professional for a patient younger than five, during the initial time interval.
Medicare pays $55.97–$60.00 for 99151 in the office in Missouri, from Rest Of Missouri to Metropolitan St. Louis. Which amount applies depends on the service address.
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 9 sections
What 99151 covers
This code describes moderate sedation delivered by the physician or qualified health professional who also performs the diagnostic or therapeutic procedure. An independent trained observer assists with monitoring the patient’s consciousness and physiologic status. A typical situation is an image-guided procedure, such as a biopsy, when the proceduralist provides the sedation. The patient must be younger than five years.
Report this code for the initial 15-minute intra-service interval. Documentation should identify the patient’s age, the supported procedure, the clinician providing both services, the observer, and sedation start and stop times. Use a different code when another physician or qualified health professional provides the sedation. Additional intra-service time is reported with 99153 when supported by the service and documentation. Medicare fee-schedule valuation is shown separately from this description.
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 99151 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
3 payment localities
$55.97 to $60.00
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City | $59.39 | $20.82 |
| Metropolitan St. Louis | $60.00 | $20.88 |
| Rest Of Missouri | $55.97 | $20.56 |
How the 99151 rate is calculated
Each of 99151’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 · 99151
RVUs × geographic indexes × conversion factor
Work0.50
0.50 RVUs× 1.000 GPCI
Practice expense1.33
1.33 RVUs× 1.000 GPCI
Malpractice0.03
0.03 RVUs× 1.000 GPCI
Adjusted RVUs
1.8600
Conversion factor
$33.4009
Medicare rate
$62.13
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 99151
99151 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.
Place of service · 99151
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$62.13
- Non-facility (office)
- $62.13
- Facility
- $21.04
Higher because the practice carries its own overhead.
99151 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 99152Moderate sedation
- Both describe initial moderate sedation by the proceduralist; select 99151 for a patient younger than five and 99152 for a patient age five or older.
- 99155Moderate sedation
- For a patient younger than five, use 99155 when a different physician or qualified health professional provides the sedation rather than the proceduralist.
- 99153Moderate sedation
- 99151 reports the initial 15-minute interval. Code 99153 reports each additional qualifying 15-minute interval.
- 99156Moderate sedation
- 99156 is the initial service when another clinician provides sedation to a patient age five or older; 99151 is for the proceduralist’s sedation of a younger patient.
99151 billing questions
When should 99151 be used instead of 99152?
Use 99151 for a patient younger than five when the proceduralist provides the moderate sedation. Code 99152 is for the same-proceduralist service when the patient is five or older.
Does 99151 apply when a different clinician provides the sedation?
No. For a patient younger than five, 99155 is the corresponding initial service when a different physician or qualified health professional provides the sedation.
What time does 99151 represent?
It represents the initial 15-minute intra-service interval. Additional qualifying intra-service time may be reported with 99153.
What documentation supports reporting 99151?
Document the patient’s age, the procedure supported by sedation, the proceduralist’s role in providing sedation, the trained observer, monitoring, and intra-service start and stop times.
Is medication administration alone enough to report 99151?
No. The record should support the moderate-sedation service, including the proceduralist’s role and the observer’s monitoring assistance, rather than medication administration alone.
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
Fee sheets
Put 99151 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →