CPT 99152
Global XXX ActiveMod sed same phys/qhp 5/>yrs
CPT 99152 Billing & Documentation Guide
CPT code 99152 (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 0.25, a non-facility practice expense RVU of 1.26, and a malpractice RVU of 0.03, a total non-facility RVU of 1.54 and facility RVU of 0.33. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $53.3, though rates vary from $45.02 to $70.49 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 99152, 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 99152 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 2 units of 99152 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 99152
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.25 | 0.25 |
| Practice Expense RVU | 1.26 | 0.05 |
| Malpractice RVU | 0.03 | 0.03 |
| Total RVU | 1.54 | 0.33 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 99152
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 | $58.99 | $11.17 | $55.15 - $70.49 | 29 |
| Florida | $52.52 | $11.97 | $50.09 - $54.69 | 3 |
| Georgia | $49.71 | $11.16 | $47.08 - $52.34 | 2 |
| Illinois | $50.96 | $11.91 | $48.34 - $53.41 | 4 |
| Michigan | $49.28 | $11.33 | $47.91 - $50.65 | 2 |
| North Carolina | $48.26 | $10.55 | $48.26 - $48.26 | 1 |
| New York | $57.06 | $11.97 | $49.04 - $60.78 | 5 |
| Ohio | $47.78 | $10.89 | $47.78 - $47.78 | 1 |
| Pennsylvania | $50.72 | $11.13 | $47.93 - $53.51 | 2 |
| Texas | $50.76 | $10.97 | $47.58 - $53.78 | 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 99152
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 99152 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 99152
What does CPT code 99152 mean? +
CPT code 99152 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 99152? +
The 2026 Medicare national average non-facility payment for CPT 99152 is $53.3. Rates range from $45.02 to $70.49 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 99152? +
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 99152? +
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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