CPT 99381 Fee Schedule
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.
| Key Fact | Detail |
|---|---|
| Service Type | • Evaluation and Management • Preventive Medicine Services |
| Common Place of Service | • 11 - Office • 50 - Federally Qualified Health Center |
| Common Modifiers | • None • 25 - Significant, separately identifiable E/M service same day • EP - Residential facility to Physician's office |
| Complexity Level | Moderate |
National average reimbursement for CPT 99381 by major payers:
$136.80
$130.25
$132.17
$167.73
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 99381 | ||||||
United | 99381 | $136.47 | 1942395447 - JOANNE WILLS | 526049658 - GREATER BALTIMORE MEDICAL CENTER | MD | Family Medicine Physician (207Q00000X) |
United | 99381 | $187.35 | 1811454028 - JESSICA PATEL | 954526112 | CA | Family Medicine Physician (207Q00000X) |
United | 99381 | $231.82 | 1629282264 - FRANCISCA BRUNEY | 461322238 | MD | Family Medicine Physician (207Q00000X) |
United | 99381 | $116.87 | 1790983229 - RAUL NAJERA | 260567806 - EP OPTIMUM HEALTH CENTER, PA | TX | Adult Medicine Physician (207QA0505X) |
United | 99381 | $68.30 | 1073597738 - JAMES BROWN | 330871036 | CA | Family Medicine Physician (207Q00000X) |
United | 99381 | $260.47 | 1619083508 - RICHARD KOLODRUBETZ | 461322238 | MD | Family Medicine Physician (207Q00000X) |
United | 99381 | $99.94 | 1083082481 - GARLAND INTEGRATED HEALTHCARE PLLC | 383991025 - GARLAND INTEGRATED HEALTHCARE PLLC | TX | Adult Medicine Physician (207QA0505X) |
United | 99381 | $459.86 | 1558546341 - REGAN CHAN | 330567576 | CA | Family Medicine Physician (207Q00000X) |
United | 99381 | $203.86 | 1164614764 - HAROON AKHTAR | 541973284 | MD | Family Medicine Physician (207Q00000X) |
United | 99381 | $84.51 | 1841902004 - WELLINGTON PROVIDER GROUP PC | 873004108 | MD | Family Medicine Physician (207Q00000X) |
United | 99381 | $173.24 | 1013085505 - RAKESH ARORA | 202265068 - INTERNAL MEDICINE ASSOCIATES OF RESTON | MD | Family Medicine Physician (207Q00000X) |
United | 99381 | $141.19 | 1649422338 - CARLOS O'BRYAN-BECERRA | 956000944 | CA | Family Medicine Physician (207Q00000X) |
United | 99381 | $116.87 | 1215594577 - GRAPEVINE TOTAL WELLNESS PLLC | 841814931 - GRAPEVINE TOTAL WELLNESS PLLC | TX | Adult Medicine Physician (207QA0505X) |
United | 99381 | $97.45 | 1356335095 - KELLIE SMALDORE | 521909348 - DRS STEVE KELLIE SMALDORE MDVIP PRACTICE INC | MD | Family Medicine Physician (207Q00000X) |
United | 99381 | $90.37 | 1679983662 - CITYWIDE HOUSECALLS, LLC | 465521761 - CITYWIDE HOUSECALLS LLC | TX | Adult Medicine Physician (207QA0505X) |
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 |
Want to see your competitors' rates?
Start your trial today to unlock complete access to provider rates and fee schedules in your area.
Here's what you can do with PayerPrice
Renegotiate your managed care contracts
Benchmark your current rates against market averages to identify opportunities for rate optimization.
Prospect for new business using fee schedules
Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.
Integrate real-time payer data into your workflows
Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.
PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.
CPT 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 | Low | 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/ Laboratory/Diagnostic Procedures New Patient; Infant (Age Younger Than 1 Year) |
| 99382 | Low | 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 | Low | 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 | Low | 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/ 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.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 99381) and we'll show you how you compare in 15 minutes or less.
Medicare Reimbursement Lookup Tool
PayerPrice provides a free medicare lookup tool for physician fee schedule, drug ASP, MS-DRG weights, anesthesia conversion factors and other medicare related data.