`99153` Mod sed same phys/qhp ea

What 99153 is

CMS fee schedule short descriptor: Mod sed same phys/qhp ea.

Full CPT long descriptions are licensed by the American Medical Association and are not published on this site; the short descriptor above is the one CMS prints in its own fee schedule file. See About CPT.

Medicare payment for 99153 (CY2026)

	Work RVU	Practice expense RVU	Malpractice RVU	Total	Medicare rate
Non-facility (office)	0.00	0.35	0.02	0.37	$12.36
Facility (hospital, ASC)	0.00	0.35	0.02	0.37	$12.36

National rates: total RVUs x the CY2026 conversion factor of 33.4009 (non-QP), before geographic adjustment. Actual Medicare payment is 80% of the rate shown after the deductible; the patient or secondary payer owes the 20% coinsurance.

Adjust for a Medicare locality:

Status: Active - payable under the Physician Fee Schedule. Global period: Add-on code: global period of the primary procedure applies.

Medically Unlikely Edit (MUE)

Medicare caps 99153 at 9 units per date of service for practitioner claims (MAI 3 - date of service edit (clinical): units above the MUE may pay with documentation on appeal), rationale: Clinical: CMS Workgroup. Units above the cap are denied unless the edit's adjudication rules allow an appeal with documentation.

Billed with 99153? These codes are bundled into it

99153 is a Column 1 code in 7 active NCCI PTP edits. When one of these Column 2 codes is reported on the same date of service, it is denied as bundled - unless the edit's modifier indicator is 1 and documentation supports a distinct service with an NCCI-associated modifier.

Column 2 code	Short description	Modifier indicator
`36591`	Draw blood off venous device	0 - no modifier bypass	Check pair
`36592`	Collect blood from picc	0 - no modifier bypass	Check pair
`94760`	N-invas ear/pls oximetry 1	0 - no modifier bypass	Check pair
`94761`	N-invas ear/pls oximetry mlt	0 - no modifier bypass	Check pair
`94762`	N-invas ear/pls oximtry cont	1 - modifier may bypass	Check pair
`96523`	Irrig drug delivery device	0 - no modifier bypass	Check pair
`99497`	Advncd care plan 30 min	1 - modifier may bypass	Check pair

99153 is bundled into these codes

99153 appears as a Column 2 code in 359 active edits. Reported with one of these Column 1 codes on the same date of service, 99153 is the code that denies.

Column 1 code	Short description
`00100`	Anes px salivary gland w/bx	Check pair
`00102`	Anes px plstc rpr cleft lip	Check pair
`00103`	Anes rcnstv px eyelid	Check pair
`00104`	Anes electroconvulsive ther	Check pair
`00120`	Anes px ear w/bx nos	Check pair
`00124`	Anes px ear otoscopy	Check pair
`00126`	Anes px ear tympanotomy	Check pair
`00140`	Anes procedures on eye nos	Check pair
`00142`	Anes px on eye lens surgery	Check pair
`00144`	Anes px eye corneal trnspl	Check pair
`00145`	Anes px eye vitreortnl surg	Check pair
`00147`	Anes px on eye iridectomy	Check pair
`00148`	Anes px eye ophthalmoscopy	Check pair
`00160`	Anes px nose&sinus nos	Check pair
`00162`	Anes px nose&sinus rad surg	Check pair

Data: CMS CY2026 Physician Fee Schedule RVU file (October release, RVU26D) and Medicare NCCI PTP practitioner edits v32.3 (2026 Q4). Verify against the official files before billing or contracting decisions.