How Much Does Moderate Sedation (First 15 Minutes) Cost?
Also known as: Mod sed same phys/qhp 5/>yrs (CPT 99152)
Medication given to make you relaxed and drowsy during a procedure while remaining conscious.
Moderate Sedation (First 15 Minutes) (CPT 99152) costs $11 at Medicare rates.
Patient Guide: Moderate Sedation (First 15 Minutes)
What you need to know before your appointment
What to Expect
An IV is placed and sedation medication is given. You feel relaxed and drowsy but can still respond to instructions. Your breathing and heart are monitored.
How Long Does It Take?
15 minutes of sedation
Common Reasons Doctors Order This
Colonoscopy, joint injection, fracture reduction, minor surgery, dental procedure
How to Prepare
Fast for 6-8 hours before. Arrange a ride home. Do not drive or make important decisions for 24 hours after.
Procedures Commonly Done Together
These procedures are frequently performed alongside Mod sed same phys/qhp 5/>yrs
How to Reduce Your Cost for Mod sed same phys/qhp 5/>yrs
Practical tips that can save you hundreds or thousands of dollars
- 1 Ask about cash-pay discounts
Many hospitals and clinics offer 20-40% discounts for self-pay patients. Always ask before scheduling.
- 2 Compare facility vs. office setting costs
For this procedure, the office rate ($51) differs from the facility rate ($11). Ask if it can be done in an office setting.
- 3 Shop around — costs vary significantly
Costs can vary 2-3x between providers in the same city. Get quotes from multiple facilities.
How is the Price Calculated?
Medicare calculates procedure payments using Relative Value Units (RVUs). Each procedure has three components multiplied by a conversion factor ($33.40 in 2026) and adjusted by geographic cost indices.
Payment = Total RVU (1.54) x CF ($33.40) = $51
Related Procedures
Similar procedures in the same category or body system
Frequently Asked Questions
How much does Mod sed same phys/qhp 5/>yrs cost?
The Medicare facility rate for Mod sed same phys/qhp 5/>yrs is $11. Commercial insurance rates typically range from 150% to 250% of Medicare (varies by plan).
How much does Mod sed same phys/qhp 5/>yrs cost without insurance?
Without insurance, the cost of Mod sed same phys/qhp 5/>yrs can range from 150% of Medicare to 500% of Medicare depending on the facility. Many hospitals and clinics offer self-pay discounts of 20-40% off their chargemaster price. Always ask about cash pricing before your visit.
Does insurance cover Mod sed same phys/qhp 5/>yrs?
Most commercial health insurance plans and Medicare cover Mod sed same phys/qhp 5/>yrs when ordered by a physician for a medically necessary reason. Your out-of-pocket cost depends on your plan's deductible, copay/coinsurance structure, and whether you use an in-network provider. Check with your insurance company before scheduling to confirm coverage and get a cost estimate.
Why does the cost vary so much by location?
Medicare adjusts payments using Geographic Practice Cost Indices (GPCIs) that reflect local differences in physician work costs, practice expenses, and malpractice insurance. Manhattan, San Francisco, and other high-cost areas pay significantly more than rural regions. Commercial insurers follow similar geographic patterns.