PFS ExplorerMedicare Physician Fee Schedule · 2026

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99205

Office o/p new hi 60 min

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Code typePrimary
Payment statusActive (A)
Global periodNone

Pricing with Related Codes

Line
Qty
Global fee
Pro fee
Primary99205Office o/p new hi 60 min
1
$236.81
$160.32
Add-on15853Removal sutr/stapl xreq anes
0
$13.36/ unit
$13.36/ unit
Add-on15854Removal sutr&stapl xreq anes
0
$17.70/ unit
$17.70/ unit
Add-on90833Psytx w pt w e/m 30 min
0
$81.50/ unit
$65.80/ unit
Add-on90836Psytx w pt w e/m 45 min
0
$103.21/ unit
$83.17/ unit
Add-on90838Psytx w pt w e/m 60 min
0
$136.61/ unit
$110.22/ unit
Add-on96160Pt-focused hlth risk assmt
0
$3.01/ unit
$3.01/ unit
Add-on96161Caregiver health risk assmt
0
$3.34/ unit
$3.34/ unit
Add-on99415Prolng clin staff svc 1st hr
0
$23.05/ unit
$23.05/ unit
Add-on99417Prolng op e/m each 15 min
0
$0.00/ unit
$0.00/ unit
Add-on99459Pelvic examination
0
$17.37/ unit
$17.37/ unit
Add-onG0506Comp asses care plan ccm svc
0
$66.47/ unit
$38.41/ unit
Add-onG2211Complex e/m visit add on
0
$17.37/ unit
$14.36/ unit
Add-onG2212Prolong outpt/office vis
0
$34.07/ unit
$27.39/ unit
Whole procedure · 3.50 wRVU credited
$236.81
$160.32
How these numbers were computed
  • status=IThis code is not separately payable under the Physician Fee Schedule (status I) — amounts shown are $0.

RVU Breakdown

Component
Office
Facility
Work
3.50
3.50
Practice expense
3.23
0.94
Malpractice
0.36
0.36
Total RVU
7.09
4.80

Payment Policy & Modifiers

Allowed adjustments
Assistant surgeon -80/81/8216% · documented
Assistant at surgery (mod 80/81/82) paid at 16% if medical necessity is documented.
Not applicable to this code
Bilateral -50Multiple procedure Co-surgeon -62Team surgeon -66Prof / tech split