What factors affect CPT 99374 fee schedules?

Factors affecting fee schedules for CPT 99374 include Medicare & Medicaid rates (government-set), private insurance rates (negotiated), geographic location (costs may be higher in urban areas), and provider type (hospital vs. private practice).

How does CPT 99374 compare to other Care Plan Oversight Services codes?

CPT 99374 is part of the Evaluation and Management services for Care Plan Oversight. It involves more provider time and moderate medical decision-making compared to lower-level codes, typically including multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation.

How can I find out the cost of a medical procedure before I get it?

To get an estimate for a specific medical procedure, you can use tools that provide price transparency. For accurate, location-specific pricing based on CPT codes, we recommend using a service like Payerprice. They offer a fee schedule lookup tool where you can search with the CPT code and your specific location.

What is a CPT code, and why is it important for understanding healthcare costs?

CPT stands for Current Procedural Terminology. CPT codes are standardized five-digit codes used by healthcare providers to describe medical, surgical, and diagnostic services. They are crucial for understanding healthcare costs because they are the universal language used for billing and determining reimbursement from insurance companies. Knowing the CPT code for a service allows you to look up its price more accurately.

Why do healthcare prices vary so much between different providers or locations?

Healthcare prices can vary significantly due to several factors, including negotiated rates with different insurance plans, the type of facility (e.g., hospital vs. outpatient clinic), geographical location, the provider's specific expertise, and the overall market competition in an area. These variations highlight the importance of price comparison tools.

My medical bill seems too high. How can I verify if the charges are fair?

If you believe your medical bill is too high, first request an itemized bill from your provider to review all charges. Then, you can compare these charges against average costs for the same service in your area. For a precise comparison using CPT codes and your specific location, we recommend using Payerprice's fee schedule lookup tool to determine market rates. You can also contact your insurance company for clarification on covered amounts.

Is there a tool or resource where I can compare prices for healthcare services?

Yes, there are tools available to help you compare prices for healthcare services. For a comprehensive and specific search, we recommend using Payerprice. Their fee schedule lookup tool allows you to search for costs based on specific CPT codes and your location, providing transparent pricing information to help you make informed decisions.

CPT 99374 Fee Schedule

Q: What is CPT code 99374 used for?

CPT code 99374 is used by healthcare providers to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management. It represents supervision of a patient under home health agency care in a home/domiciliary environment, requiring complex and multidisciplinary care modalities.

Last Verified: July 2026

Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.

Home Health Care Supervision, Supervision Of A Patient Under Care Of Home Health Agency Patient Not Present In Home Domiciliary Or Equivalent Environment Eg Alzheimer S Facility Requiring Complex And Multidisciplinary Care Modalities Involving Regular Development And Or Revision Of Care Plans By That Individual Review Of Subsequent Reports Of Patient Status Review Of Related Laboratory And Other Studies Communication Including Telephone Calls For Purposes Of Assessment Or Care Decisions With Health Care Professional S Family Member S Surrogate Decision Maker S Eg Legal Guardian And Or Key Caregiver S Involved In Patient S Care Integration Of New Information Into The Medical Treatment Plan And Or Adjustment Of Medical Therapy Within A Calendar Month 15 29 Minutes

Key Fact	Detail
Service Type	Care Plan Oversight Services Evaluation and Management
Common Place of Service	11 - Office 99 - Other POS None
Common Modifiers	None 25 - Significant, separately identifiable E/M service same day SA
Complexity Level	Low
Medicare Fee Schedule	View Medicare rates for 99374

National average reimbursement for CPT 99374 by major payers:

$83.81

$85.72

$82.57

$106.08

Preview provider-level rates for...

For billing codeCPT 99374

Payer	Code	Rate	NPI	Tax ID	State	Specialty
United	99374	$60.59	1336376995 - ANTHONY BIENEK	824863709 - (TX) PAK MEDICAL GROUP PLLC	TX	Internal Medicine Physician (207R00000X)
United	99374	$46.47	1275534109 - MICHELLE SCANLAN	742518083 - (TX) PASTEUR MEDICAL ASSOCIATES PA	TX	Internal Medicine Physician (207R00000X)
United	99374	$107.98	1114334778 - MARGARET MANUS	300520570 - (TX) METHODIST HOSPITAL	TX	Internal Medicine Physician (207R00000X)
United	99374	$78.61	1689634883 - JAIME SILVA	742786917 - (TX) JAIME SILVA, M.D., P.A.	TX	Cardiovascular Disease Physician (207RC0000X)
United	99374	$239.77	1073711768 - JAMELAH TUCKER	590634433 - THE NEMOURS FOUNDATION	MA	Pediatrics Physician (208000000X)
United	99374	$185.75	1275981524 - ANNIE KAO	43400617 - TUFTS MEDICAL CENTER PARENT INC	MA	Pediatrics Physician (208000000X)
United	99374	$63.47	1457657371 - PHYSICIAN SERVICES OF JACKSBORO PA	263264819 - (TX) PHYSICIAN SERVICES OF JACKSBORO PA	TX	Internal Medicine Physician (207R00000X)
United	99374	$91.73	1700233970 - WILLIAM HATCH	751302152 - (TX) MOORE COUNTY HOSPITAL DISTRICT	TX	Internal Medicine Physician (207R00000X)
United	99374	$60.74	1538213517 - FIRST CARE MEDICAL CENTER	751712958 - (TX) FIRST CARE MEDICAL CENTER	TX	Internal Medicine Physician (207R00000X)
United	99374	$49.38	1386713329 - RAFIQUDDIN RAHIMI	462923863	TX	Internal Medicine Physician (207R00000X)
United	99374	$57.16	1770594939 - ROUND ROCK CARDIOLOGY, PA	743001682 - (TX) ROUND ROCK CARDIOLOGY	TX	Cardiovascular Disease Physician (207RC0000X)
United	99374	$56.27	1427160324 - BANGARUSWAMY KUMAR	1427160324 - (TX) BANGARUSWAMY KUMAR	TX	Neurology Physician (2084N0400X)
United	99374	$83.23	1831446665 - FONDA CHAN	751667190 - (TX) NEUROLOGY CONSULTANTS OF DALLAS, P.A.	TX	Neurology Physician (2084N0400X)
United	99374	$74.16	1992723241 - JACOB CHEMMALAKUZHY	844387178 - (TX) SPECIALIZED HEART CARE PLLC	TX	Cardiovascular Disease Physician (207RC0000X)
United	99374	$69.83	1477547875 - SATISH VAYUVEGULA	452819643 - (ME) CINDY ASBJORNSEN, D.O. LLC D/B/A VEIN HEALTHCARE CENTER	TX	Cardiovascular Disease Physician (207RC0000X)
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist

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CPT 99374 vs. Other Evaluation and Management Codes

The CPT 99374 code is part of the Care Plan Oversight Services services used for Evaluation and Management. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.

The CPT 99374 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.

Code	Complexity	Description
99367-CPT	Low	Team Conf W O Pat By Phys, Medical Team Conference With Interdisciplinary Team Of Health Care Professionals Patient And Or Family Not Present 30 Minutes Or More Participation By Physician
99368-CPT	Low	Team Conf W O Pat By Hc Pro, Medical Team Conference With Interdisciplinary Team Of Health Care Professionals Patient And Or Family Not Present 30 Minutes Or More Participation By Nonphysician Qualified Health Care Professional
99374-CPT	Low	Home Health Care Supervision, Supervision Of A Patient Under Care Of Home Health Agency Patient Not Present In Home Domiciliary Or Equivalent Environment Eg Alzheimer S Facility Requiring Complex And Multidisciplinary Care Modalities Involving Regular Development And Or Revision Of Care Plans By That Individual Review Of Subsequent Reports Of Patient Status Review Of Related Laboratory And Other Studies Communication Including Telephone Calls For Purposes Of Assessment Or Care Decisions With Health Care Professional S Family Member S Surrogate Decision Maker S Eg Legal Guardian And Or Key Caregiver S Involved In Patient S Care Integration Of New Information Into The Medical Treatment Plan And Or Adjustment Of Medical Therapy Within A Calendar Month 15 29 Minutes
99375-CPT	Low	Home Health Care Supervision, Supervision Of A Patient Under Care Of Home Health Agency Patient Not Present In Home Domiciliary Or Equivalent Environment Eg Alzheimer S Facility Requiring Complex And Multidisciplinary Care Modalities Involving Regular Development And Or Revision Of Care Plans By That Individual Review Of Subsequent Reports Of Patient Status Review Of Related Laboratory And Other Studies Communication Including Telephone Calls For Purposes Of Assessment Or Care Decisions With Health Care Professional S Family Member S Surrogate Decision Maker S Eg Legal Guardian And Or Key Caregiver S Involved In Patient S Care Integration Of New Information Into The Medical Treatment Plan And Or Adjustment Of Medical Therapy Within A Calendar Month 30 Minutes Or More

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99374. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 99374 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.

Factors that affect fee schedules

Medicare & Medicaid Rates

Government-set reimbursement amounts

Private Insurance Rates

Negotiated rates between providers and insurance companies

Geographic Location

Costs may be higher in urban areas.

Provider Type

Hospital providers may have different rates than private practice.

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