CPT 99155
Global XXX ActiveMod sed oth phys/qhp <5 yrs
CPT 99155 Billing & Documentation Guide
CPT code 99155 (Mod sed oth 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 1.9, a non-facility practice expense RVU of 0.3, and a malpractice RVU of 0.24, a total non-facility RVU of 2.44 and facility RVU of 2.44. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $82.08, though rates vary from $75.53 to $110.28 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 99155, 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 99155 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 99155 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 99155
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.9 | 1.9 |
| Practice Expense RVU | 0.3 | 0.3 |
| Malpractice RVU | 0.24 | 0.24 |
| Total RVU | 2.44 | 2.44 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 99155
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 | $81.94 | $81.94 | $79.82 - $89.19 | 29 |
| Florida | $89.12 | $89.12 | $85.09 - $94.17 | 3 |
| Georgia | $82.71 | $82.71 | $81.96 - $83.46 | 2 |
| Illinois | $88.69 | $88.69 | $85.14 - $92.37 | 4 |
| Michigan | $84.16 | $84.16 | $81.66 - $86.65 | 2 |
| North Carolina | $77.93 | $77.93 | $77.93 - $77.93 | 1 |
| New York | $88.55 | $88.55 | $78.62 - $94.32 | 5 |
| Ohio | $80.69 | $80.69 | $80.69 - $80.69 | 1 |
| Pennsylvania | $82.42 | $82.42 | $80.24 - $84.6 | 2 |
| Texas | $81.12 | $81.12 | $80.03 - $84.95 | 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 99155
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 99155 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 |
| 0543T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0544T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0567T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0568T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0569T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0570T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0571T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 99155
What does CPT code 99155 mean? +
CPT code 99155 represents: Mod sed oth phys/qhp <5 yrs. It's in the Anesthesia category with a global period of XXX.
What is the Medicare reimbursement for CPT 99155? +
The 2026 Medicare national average non-facility payment for CPT 99155 is $82.08. Rates range from $75.53 to $110.28 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 99155? +
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 99155? +
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 June 2, 2026.
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