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 | Low |
| Medicare Fee Schedule | View Medicare rates for 99381 |
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 | $90.37 | 1679983662 - CITYWIDE HOUSECALLS, LLC | 465521761 - CITYWIDE HOUSECALLS LLC | TX | Adult Medicine Physician (207QA0505X) |
United | 99381 | $120.90 | 1083655369 - KRUPA SHAH | 462385459 | CA | Family Medicine Physician (207Q00000X) |
United | 99381 | $84.59 | 1720298367 - HMG MEDICAL GROUP, P.A. | 208696569 - HMG MEDICAL GROUP PA | TX | Adult Medicine Physician (207QA0505X) |
United | 99381 | $198.69 | 1700867678 - JERRY REIMER | 270271872 | CA | Family Medicine Physician (207Q00000X) |
United | 99381 | $87.61 | 1679728349 - SARAH CONNOR | 521638592 - CHASE BREXTON HEALTH SERVICES INC | MD | Family Medicine Physician (207Q00000X) |
United | 99381 | $78.25 | 1497704761 - SYLVIA GARCIA | 330633863 | CA | Family Medicine Physician (207Q00000X) |
United | 99381 | $116.87 | 1124358635 - ANTHONY MRGUDICH | 943281660 | CA | Family Medicine Physician (207Q00000X) |
United | 99381 | $171.52 | 1861557035 - EUGENE TAYLOR | 800719005 | MD | Family Medicine Physician (207Q00000X) |
United | 99381 | $203.86 | 1164614764 - HAROON AKHTAR | 541973284 | MD | Family Medicine Physician (207Q00000X) |
United | 99381 | $574.78 | 1629093083 - KIM CARNAZZOLA | 954377219 | CA | Family Medicine Physician (207Q00000X) |
United | 99381 | $115.37 | 1427403617 - MARGARET CHEN | 943281657 | CA | Family Medicine Physician (207Q00000X) |
United | 99381 | $187.35 | 1992742738 - ELVIA RODRIGUEZ | 954526112 | CA | Family Medicine Physician (207Q00000X) |
United | 99381 | $122.80 | 1952468670 - MARY BRENNAN | 452526143 - MDICS REHABILITATIVE SERVICES LLC | MD | Family Medicine Physician (207Q00000X) |
United | 99381 | $505.80 | 1275892119 - NEHA CHANDE | 954372159 | CA | Family Medicine Physician (207Q00000X) |
United | 99381 | $116.87 | 1790983229 - RAUL NAJERA | 260567806 - EP OPTIMUM HEALTH CENTER, PA | 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 |
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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-CPT | 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-CPT | 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-CPT | 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-CPT | 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.
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