CPT 99151
Global XXX ActiveMod sed same phys/qhp <5 yrs
CPT 99151 Billing & Documentation Guide
CPT code 99151 (Mod sed same phys/qhp <5 yrs) is classified under Anesthesia with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.5, a non-facility practice expense RVU of 1.33, and a malpractice RVU of 0.03, a total non-facility RVU of 1.86 and facility RVU of 0.63. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $64.26, though rates vary from $55.38 to $83.13 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 99151, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 99151 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
No global period (E/M and other non-procedural services)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 99151 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 99151
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.5 | 0.5 |
| Practice Expense RVU | 1.33 | 0.1 |
| Malpractice RVU | 0.03 | 0.03 |
| Total RVU | 1.86 | 0.63 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 99151
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $70.41 | $21.79 | $66.21 - $83.13 | 29 |
| Florida | $63.22 | $22 | $60.68 - $65.48 | 3 |
| Georgia | $60.31 | $21.11 | $57.52 - $63.09 | 2 |
| Illinois | $61.6 | $21.9 | $58.82 - $64.22 | 4 |
| Michigan | $59.83 | $21.24 | $58.39 - $61.26 | 2 |
| North Carolina | $58.79 | $20.46 | $58.79 - $58.79 | 1 |
| New York | $68.41 | $22.58 | $59.61 - $72.45 | 5 |
| Ohio | $58.27 | $20.76 | $58.27 - $58.27 | 1 |
| Pennsylvania | $61.44 | $21.19 | $58.43 - $64.44 | 2 |
| Texas | $61.46 | $21.01 | $58.06 - $64.62 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 99151
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 99151 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0178T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0179T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0180T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0708T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0709T | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 0903T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0904T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0905T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 36000 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
| 36400 | Column 1 (primary), can be billed with modifier | Yes | Standards of medical/surgical practice |
Frequently Asked Questions, CPT 99151
What does CPT code 99151 mean? +
CPT code 99151 represents: Mod sed same phys/qhp <5 yrs. It's in the Anesthesia category with a global period of XXX.
What is the Medicare reimbursement for CPT 99151? +
The 2026 Medicare national average non-facility payment for CPT 99151 is $64.26. Rates range from $55.38 to $83.13 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 99151? +
Medicine section spans a wide range: therapy services use GP/GO/GN (PT/OT/SLP plans of care) and KX (above cap with documentation). Drug administration uses JW (waste) and JZ (no waste). Professional/technical split applies to some diagnostic codes.
What bundling edits apply to CPT 99151? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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