How much does Medicare pay for CPT 99152?

Medicare allowed an average of $15.74 per service and paid $12.50 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $110.91, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 99152?

Use of a drug to induce depression of consciousness by physician performing a procedure (5 years or older), initial 15 minutes. It was billed 1,329,142 times to 1,182,650 Medicare beneficiaries by 19,184 providers in 2024.

Does 99152 pay differently in an office than a hospital?

Yes. The allowed amount averaged $46.88 in an office setting and $11.77 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 99152 most?

Interventional Cardiology, with 303,121 services from 3,438 clinicians. Next are Cardiology, Diagnostic Radiology, Interventional Radiology.

CPT 99152

Use of a drug to induce depression of consciousness by physician performing a procedure (5 years or older), initial 15 minutes

$15.74Medicare-allowed amount per service, averaged across 1,329,142 services

Providers submitted

$110.91

Asking price, not received

Medicare allowed

$15.74

The fee schedule figure

Medicare paid

$12.50

Balance is patient coinsurance

Providers submitted an average of $110.91 for this code and Medicare allowed $15.74 — 7.0× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $12.50 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $46.88
Hospital / facility: $11.77

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 150,228 services were billed in an office setting and 1,178,914 in a facility.

Services: 1,329,142
Beneficiaries: 1,182,650
Providers billing it: 19,184
Total allowed: $20,920,695

What Medicare pays for CPT 99152

Across 1,329,142 services billed by 19,184 providers to 1,182,650 beneficiaries, Medicare allowed an average of $15.74 per service. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 99152

Specialty	Services	Beneficiaries	Avg allowed	Providers
Interventional Cardiology	303,121	279,069	$12.58	3,438
Cardiology	301,617	276,515	$13.18	4,609
Diagnostic Radiology	227,816	208,686	$14.29	3,231
Interventional Radiology	150,870	135,784	$15.64	1,633
Vascular Surgery	56,992	45,422	$29.15	1,158
Clinical Cardiac Electrophysiology	54,542	51,695	$11.84	986
Nephrology	33,611	24,308	$27.72	313
Pain Management	28,794	20,834	$26.33	473
Internal Medicine	28,288	25,040	$15.48	454
Anesthesiology	25,973	19,038	$25.11	436
Interventional Pain Management	19,216	13,936	$28.25	269
Physician Assistant	15,160	14,600	$11.04	372
Ophthalmology	14,190	8,895	$29.56	137
Physical Medicine and Rehabilitation	13,494	10,771	$21.42	275
Pulmonary Disease	8,372	7,256	$11.98	279

99152 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
California	126,494	$17.66	$13.02	1,717
Texas	113,468	$17.13	$13.84	1,704
Florida	102,522	$18.16	$14.24	1,382
Illinois	65,023	$15.04	$11.50	871
New York	58,712	$18.68	$13.28	793
Pennsylvania	48,895	$12.41	$9.79	710
Ohio	44,710	$12.10	$9.73	772
Virginia	43,358	$16.87	$13.36	580
Michigan	40,646	$18.75	$15.05	702
Georgia	38,785	$15.04	$12.14	603
North Carolina	38,108	$13.77	$11.46	612
Indiana	34,402	$11.80	$9.91	504
Arizona	33,403	$21.13	$17.54	487
Oklahoma	31,616	$15.65	$13.46	332
Massachusetts	31,037	$14.66	$11.12	464
Missouri	30,574	$13.21	$10.69	432
Washington	29,290	$14.46	$11.29	429
New Jersey	27,084	$14.17	$10.40	397
Tennessee	26,435	$14.32	$12.11	393
Minnesota	26,311	$12.24	$10.02	471
South Carolina	25,760	$14.11	$11.70	321
Wisconsin	25,360	$11.79	$9.88	464
Louisiana	22,023	$13.94	$11.49	343
Mississippi	21,041	$13.79	$11.74	224
Maryland	19,454	$22.63	$16.65	221
Arkansas	19,274	$14.22	$12.41	210
Kentucky	19,060	$14.28	$11.84	288
Colorado	16,797	$16.88	$13.20	313
Kansas	15,536	$12.77	$10.84	184
Alabama	15,065	$14.55	$12.48	244
Iowa	14,930	$11.72	$9.92	180
Oregon	12,047	$15.83	$12.57	218
Utah	11,801	$24.96	$20.97	172
Connecticut	11,059	$19.00	$13.90	191
Nebraska	10,072	$14.05	$12.05	129
Nevada	10,067	$14.22	$11.41	173
South Dakota	9,031	$15.83	$12.93	71
Idaho	7,639	$11.65	$9.92	118
New Hampshire	6,699	$11.68	$9.27	93
New Mexico	6,498	$17.35	$14.28	91
Montana	5,836	$11.71	$9.34	68
North Dakota	5,732	$11.40	$9.37	54
West Virginia	4,789	$11.76	$9.35	89
Delaware	4,060	$18.80	$15.03	57
Rhode Island	4,050	$12.83	$9.88	70
Maine	3,832	$11.45	$9.20	73
Alaska	2,889	$23.37	$14.97	31
District of Columbia	2,410	$14.31	$10.51	47
Hawaii	2,115	$18.52	$14.27	33
Vermont	1,799	$12.86	$10.07	21
Wyoming	616	$13.73	$11.43	12
Puerto Rico	468	$26.65	$21.01	20
Guam	386	$31.07	$21.69	5
U.S. Virgin Islands	74	$11.76	$9.24	1

Related codes

99153Use of a drug to induce depression of consciousness by physician perfo$11.53
99183Management of oxygen chamber therapy$102.12
99195Drawing of blood for a medical problem$93.96
99157Use of a drug to induce depression of consciousness by physician not p$57.09
99156Use of a drug to induce depression of consciousness by physician not p$70.75

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.