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See a sample rate comparisonCPT 99384 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.
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
| 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 99384 |
| Medicaid Fee Schedule | $109.80 median of the 8 states in the free preview · View Medicaid rates for 99384 |
National average reimbursement for CPT 99384 by major payers:
$155.45
$153.78
$160.97
$200.15
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CPT 99384
5 of 25 sample ratesHigher to lower in this preview
Ligeia Damaso
The Nemours Foundation
$466.82Published rateWarren Kammerer
Warren Kammerer Md Sc
$206.58Published rateEmad Amer
Amer Associates Sc
$140.19Published ratePhilip Wilson
Regenerative Medicine Of Alabama
$131.11Published rateAriel Mir Remedios
$75.26Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 99384 vs. Other Preventive Medicine Services Codes
The CPT 99384 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 99384 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 |
|---|---|---|
| 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 |
| 99385-CPT | Low | Prev Visit New Age 18 39, 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 18 39 Years |
| 99386-CPT | Low | Prev Visit New Age 40 64, 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 40 64 Years |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99384. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99384 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
A CPT (Current Procedural Terminology) code is a five-digit numerical code used by medical professionals to uniformly describe medical, surgical, and diagnostic services and procedures. These codes are essential for billing, processing insurance claims, and determining the cost of services.
To find the cost of a specific medical procedure or service, you'll typically need the CPT code for that service and your specific location. Websites like Payerprice offer fee schedule lookup tools that allow you to search for pricing information using a CPT code and location, giving you an estimate of what providers might charge. This can help you understand potential out-of-pocket costs before a procedure.
Billed charges (or list prices) are the amounts healthcare providers initially charge for services. What you actually pay, your "out-of-pocket" cost, is often different. This amount is influenced by your insurance plan (deductibles, co-pays, co-insurance), negotiated rates between your insurer and the provider, and whether you've met your annual maximums. Payerprice can help you understand the provider's fee schedule, but your final payment will depend on your specific insurance benefits.
Healthcare prices vary widely due to several factors, including the specific provider or facility, geographic location, insurance company negotiations, the complexity of the service, and whether the provider is in-network or out-of-network. There's often no standardized price for a given service across different providers or regions. Tools like Payerprice can help you compare these varying costs for specific services.
To compare prices for healthcare services effectively, you'll need the CPT code for the service and your location. You can then use price transparency tools such as Payerprice's fee schedule lookup. This tool allows you to input a CPT code and location to find estimated prices from different providers, helping you make informed decisions and potentially save money.
No, insurance typically does not cover all costs. Most insurance plans involve out-of-pocket expenses such as deductibles (the amount you pay before your insurance starts to cover costs), co-pays (a fixed amount you pay for a service), and co-insurance (a percentage of the cost you pay after your deductible is met). It's crucial to understand your specific insurance plan's benefits to estimate your final costs. While Payerprice provides provider fee schedules, you should also contact your insurance company for details on your specific coverage.
To accurately look up healthcare prices, you generally need the specific CPT code for the medical procedure or service you're interested in, and your geographic location (zip code or city/state). Having your insurance information on hand can also be helpful when estimating your final out-of-pocket costs. Payerprice's tool specifically utilizes CPT codes and location for its fee schedule lookup.