What is the standard insurance baseline for CPT 99152?

The standard insurance baseline reimbursement rate is $12.27. This represents the customary allowable amount established across standard fee schedules.

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CPT 99152Medical Service

Use of a Drug to Induce Depression of Consciousness by Physician Performing a Procedure 5 Years or Older

Q: What do doctors typically charge for Use of a Drug to Induce Depression of Consciousness by Physician Performing a Procedure 5 Years or Older?

The nationwide median physician charge for Use of a Drug to Induce Depression of Consciousness by Physician Performing a Procedure 5 Years or Older (CPT 99152) is $99.00. Doctor billed charges vary based on geographic region, setting, and overhead.

Use of a drug to induce depression of consciousness by physician performing a procedure (5 years or older), initial 15 minutes. Clinical pricing breakdown and utilization metrics across 19,266 practicing doctors nationwide.

$99.00

Peer Median Charge

Gross billed rate

$12.27

Standard Baseline

Customary allowable

8.1x

National Markup

Charge vs baseline

19,266

Active Physicians

Billing this code

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Understanding This Medical Fee

Gross Charge vs Negotiated Payment: The median physician charge for this service is $99.00. However, insured patients almost never pay this full amount directly. Insurers negotiate rates down toward the $12.27 baseline.

Self-Pay & Uninsured Guidance: If you are paying without insurance or out-of-network, request a prompt-pay cash discount. Most medical practices are willing to settle self-pay bills near the customary baseline rate rather than the full gross charge.

Key Questions for Your Doctor's Billing Office:

"Does Dr. [Name] participate in my specific insurance plan network?"
"What is the total self-pay or cash rate for code 99152 if paid upfront?"
"Are there separate facility, anesthesia, or pathology fees associated with this procedure?"