Billing code 99415: Prolonged staff careMedicare rate & RVUs in Texas
Reports the first-hour add-on for extended direct-contact clinical staff service during an office or outpatient E/M encounter under physician supervision.
Medicare pays $20.98–$24.33 for 99415 in the office in Texas, from Beaumont to Austin. 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 99415 covers
99415 captures prolonged, direct-contact clinical staff work during an office or other outpatient evaluation and management encounter, beyond the time ordinarily associated with that visit. Clinical staff perform the service under physician supervision; the code does not represent extra time personally spent by the physician or other qualified health care professional. It applies when staff remain engaged with the patient during an extended outpatient encounter, rather than for administrative work or unattended waiting time.
Report 99415 with the related office or outpatient E/M primary service. Document the reason for the extension and the clinical staff’s direct-contact time to support the reported service. This is an add-on, paid within the primary service’s global period, not a standalone visit. CMS classifies it as technical-component-only; any separately covered interpretation is represented by its distinct code. Use 99416 for qualifying additional prolonged clinical staff time.
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 99415 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 payment localities
$20.98 to $24.33
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | $24.33 | Unavailable |
| Beaumont | $20.98 | Unavailable |
| Brazoria | $22.77 | Unavailable |
| Dallas | $22.91 | Unavailable |
| Fort Worth | $22.69 | Unavailable |
| Galveston | $22.83 | Unavailable |
| Houston | $23.01 | Unavailable |
| Rest Of Texas | $21.86 | Unavailable |
How the 99415 rate is calculated
Each of 99415’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 · 99415
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.00Practice expense 0.68Malpractice 0.01
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 99415
The CMS indicators that decide how 99415 is paid alongside other services.
CMS payment indicators · 99415
Prolonged staff care
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 3 | Technical component only. |
99415 compared with similar codes
Compare codes
99415 vs 99416 vs 99417 vs 99418: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 99416Prolonged staff service
- 99415 reports the first-hour prolonged clinical staff service; 99416 reports qualifying additional prolonged staff time.
- 99417Prolng op e/m each 15 min
- 99415 is for direct-contact clinical staff time during an office or outpatient E/M encounter. 99417 is for prolonged time attributable to the E/M professional.
- 99418Prolng ip/obs e/m ea 15 min
- 99415 concerns prolonged clinical staff service in an office or outpatient E/M encounter; 99418 is the prolonged E/M service code for inpatient or observation care.
99415 billing questions
When should I choose 99415 instead of 99417?
Use 99415 for prolonged direct-contact time furnished by clinical staff during an office or outpatient E/M encounter. 99417 describes prolonged time attributable to the E/M professional, not the clinical staff service.
What primary service must accompany 99415?
Report it with the related office or outpatient E/M service as an add-on. CMS pays it within that primary service’s global period.
Can I report 99415 for staff documentation or waiting time?
The service is for prolonged direct patient contact by clinical staff under physician supervision. Administrative documentation or time when staff are not engaged directly with the patient does not establish that service.
How do I report additional prolonged staff time?
99415 represents the first-hour add-on. Report 99416 for qualifying additional prolonged clinical staff time, supported by documentation of the direct-contact service and its duration.
Does 99415 represent the interpretation component?
CMS classifies 99415 as technical-component-only. A separately covered interpretation is represented by its distinct code.
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 99415 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 →