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See a sample rate comparisonCPT 99381 Fee Schedule
Last Verified: October 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.
Init Pm E M New Pat Infant, Initial Comprehensive Preventive Medicine Evaluation And Management Of An Individual Including An Age And Gender Appropriate History Examination Counseling Anticipatory Guidance Risk Factor Reduction Interventions And The Ordering Of Laboratory Diagnostic Procedures New Patient Infant Age Younger Than 1 Year
| Key Fact | Detail |
|---|---|
| Service Type | Evaluation and Management Preventive Medicine Services |
| Common Place of Service | 11 - Office 50 - Federally Qualified Health Center |
| Common Modifiers | 25 - Significant, separately identifiable E/M service same day EP - Residential facility to Physician's office |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 99381 |
| Medicaid Fee Schedule | $90.25 median of the 8 states in the free preview · View Medicaid rates for 99381 |
National average reimbursement for CPT 99381 by major payers:
$136.80
$130.25
$132.17
$164.65
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CPT 99381
5 of 25 sample ratesHigher to lower in this preview
Kim Carnazzola
$574.78Published rateEugene Taylor
$171.52Published rateMarcelo Brito Telles
Appraise Health Clinic PLLC
$118.61Published rateBoyd Hcs, PLLC
Boyd Hcs PLLC
$94.33Published rateJames Brown
$68.30Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 99381 vs. Other Preventive Medicine Services Codes
The CPT 99381 code is part of the Evaluation and Management services used for Preventive Medicine Services. 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 99381 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 |
|---|---|---|
| 99381-CPT | Low | Init Pm E M New Pat Infant, Initial Comprehensive Preventive Medicine Evaluation And Management Of An Individual Including An Age And Gender Appropriate History Examination Counseling Anticipatory Guidance Risk Factor Reduction Interventions And The Ordering Of Laboratory Diagnostic Procedures New Patient Infant Age Younger Than 1 Year |
| 99382-CPT | Low | Init Pm E M New Pat 1 4 Yrs, Initial Comprehensive Preventive Medicine Evaluation And Management Of An Individual Including An Age And Gender Appropriate History Examination Counseling Anticipatory Guidance Risk Factor Reduction Interventions And The Ordering Of Laboratory Diagnostic Procedures New Patient Early Childhood Age 1 Through 4 Years |
| 99383-CPT | Low | Prev Visit New Age 5 11, Initial Comprehensive Preventive Medicine Evaluation And Management Of An Individual Including An Age And Gender Appropriate History Examination Counseling Anticipatory Guidance Risk Factor Reduction Interventions And The Ordering Of Laboratory Diagnostic Procedures New Patient Late Childhood Age 5 Through 11 Years |
| 99384-CPT | Low | Prev Visit New Age 12 17, Initial Comprehensive Preventive Medicine Evaluation And Management Of An Individual Including An Age And Gender Appropriate History Examination Counseling Anticipatory Guidance Risk Factor Reduction Interventions And The Ordering Of Laboratory Diagnostic Procedures New Patient Adolescent Age 12 Through 17 Years |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99381. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99381 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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Frequently Asked Questions
CPT 99381 is a medical code used by healthcare providers to document and receive reimbursement for initial comprehensive preventive medicine evaluation and management of a new patient, infant (age younger than 1 year), involving moderate-level medical decision-making.
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99381. These prices vary significantly depending on payer type (Medicare, Medicaid, private insurance), geographic location, and specific provider contracts. To find the fee schedule for your specific CPT code and location, you can use Payerprice's fee schedule lookup tool.
Factors affecting CPT 99381 fee schedules include government-set rates for Medicare and Medicaid, negotiated rates with private insurance companies, the geographic location (as costs can be higher in urban areas), and the type of provider (e.g., hospital vs. private practice). Due to these variations, it's best to use a specialized tool to determine the exact fee schedule for your specific CPT code and location. Payerprice offers a fee schedule lookup tool for this purpose.