99205
ActiveGlobal n/aOffice o/p new hi 60 min
2026 Medicare payment
Estimated allowed amounts. Pick a locality or enter a ZIP; toggle modifiers to see how the payment rules change the number; add the add-on codes to price the whole procedure.
| Line | Qty | Non-facility (office) | Facility (hospital/ASC) |
|---|---|---|---|
| 99205 | 1 | $236.81 | $160.32 |
| add-on15853 | 0 | $13.36/ unit | $13.36/ unit |
| add-on15854 | 0 | $17.70/ unit | $17.70/ unit |
| add-on90833 | 0 | $81.50/ unit | $65.80/ unit |
| add-on90836 | 0 | $103.21/ unit | $83.17/ unit |
| add-on90838 | 0 | $136.61/ unit | $110.22/ unit |
| add-on96160 | 0 | $3.01/ unit | $3.01/ unit |
| add-on96161 | 0 | $3.34/ unit | $3.34/ unit |
| add-on99415 | 0 | $23.05/ unit | $23.05/ unit |
| add-on99417 | 0 | $0.00/ unit | $0.00/ unit |
| add-on99459 | 0 | $17.37/ unit | $17.37/ unit |
| add-onG0506 | 0 | $66.47/ unit | $38.41/ unit |
| add-onG2211 | 0 | $17.37/ unit | $14.36/ unit |
| add-onG2212 | 0 | $34.07/ unit | $27.39/ unit |
RVU breakdown (national)
Relative value units before geographic adjustment. Payment = (work×GPCIw + PE×GPCIpe + MP×GPCImp) × CF
| Row | Work RVU | PE RVU (office) | PE RVU (facility) | MP RVU | Total (office) |
|---|---|---|---|---|---|
| 99205 | 3.50 | 3.23 | 0.94 | 0.36 | 7.09 |
Payment policy for 99205
CMS's indicator fields, translated. These control which modifiers are payable and how.
Professional/technical (PC/TC)
pctc=0Physician service
Cannot be split into professional/technical components — modifiers 26 and TC don't apply.
Multiple procedures
mult_surg=0No reduction
No multiple-procedure payment adjustment applies (typical for add-on codes).
Bilateral (modifier 50)
bilt_surg=0150% rule doesn't apply
Bilateral adjustment does not apply (e.g., the code is unilateral by definition or physiology).
Assistant surgeon (80/81/82)
asst_surg=0Payable with documentation
Assistant at surgery (mod 80/81/82) paid at 16% if medical necessity is documented.
Co-surgeons (modifier 62)
co_surg=0Not permitted
Co-surgeons (mod 62) may not be paid for this procedure.
Team surgery (modifier 66)
team_surg=0Not permitted
Team surgery (mod 66) may not be paid for this procedure.
Source: pfs.data.cms.gov "Indicators for 2026", retrieved 2026-07-16; conversion factors $33.4009 / $33.5675 (QP) per CMS-1832-F. Estimated amounts — not billing or coding advice.