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See a sample rate comparisonCPT 99385 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 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
| 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 SA |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 99385 |
| Medicaid Fee Schedule | $106.745 median of the 8 states in the free preview · View Medicaid rates for 99385 |
National average reimbursement for CPT 99385 by major payers:
$152.42
$150.19
$155.62
$195.21
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CPT 99385
5 of 25 sample ratesHigher to lower in this preview
Divya Viswanathan
Sutter Bay Medical Foundation
$480.27Published rateKelly Ridges
Allergy & Asthma Of Dupage, S.C.
$176.21Published rateJoni Faye Jabonite
Optumcare Florida, LLC
$134.21Published rateApril Rojas
Sunset Community Health Center
$115.94Published rateJennifer Herrera
Good Health Medical, P.C.
$81.48Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 99385 vs. Other Preventive Medicine Services Codes
The CPT 99385 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 99385 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 |
|---|---|---|
| 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 |
| 99387-CPT | Low | Init Pm E M New Pat 65 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 65 Years And Older |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99385. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99385 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
To find out the cost of a medical procedure before you have it, you should ideally contact your insurance provider directly or the healthcare facility's billing department for an estimate based on your specific plan and circumstances. For a general estimate or to compare prices for specific CPT codes and locations, you can use tools like Payerprice, which offers a fee schedule lookup tool tailored for this purpose.
CPT (Current Procedural Terminology) codes are a standardized set of five-digit codes used by healthcare professionals to report medical, surgical, and diagnostic procedures and services to entities such as physicians, health insurance companies, and accreditation organizations. They are essential for accurate medical billing and processing insurance claims, as they define the specific services rendered, which in turn influences the cost and reimbursement.
Medical costs can vary significantly between providers due to a multitude of factors, including: the provider's negotiated rates with different insurance companies, the complexity of the procedure, geographic location, the type of facility (e.g., hospital vs. outpatient clinic), the provider's reputation or specialization, and whether the provider is in-network or out-of-network for your insurance plan.
While there isn't one single "standard" price due to the variability mentioned, you can look for price transparency tools. For specific procedure codes (CPT codes) and locations, tools like Payerprice offer fee schedule lookup services that can help you understand potential costs. Your insurance provider's website might also offer cost estimators for certain services, and some state health departments or non-profit organizations compile price data.
If you receive a medical bill that seems too high, first review it carefully for any errors, incorrect codes, or services you didn't receive. Next, contact the billing department of the healthcare provider to request an itemized bill and ask for an explanation of the charges. Simultaneously, contact your insurance company to understand what was covered and why. If discrepancies remain, you can negotiate with the provider for a lower price or payment plan. For understanding typical costs for specific CPT codes in your area, Payerprice can be a useful resource to compare the billed amount against.