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See a sample rate comparisonCPT 99386 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 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
| 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 99386 |
| Medicaid Fee Schedule | $123.005 median of the 8 states in the free preview · View Medicaid rates for 99386 |
National average reimbursement for CPT 99386 by major payers:
$173.97
$173.33
$179.09
$225.74
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CPT 99386
5 of 25 sample ratesHigher to lower in this preview
Stanley Savinese
$316.23Published rateKeegan Duchicela
Mochi Medical PA
$212.66Published rateMichael Lyons
Michael Lyons, M.D.
$165.57Published rateMegan Ginsburg
Advocate Health And Hospitals Corporation
$123.48Published rateNeighbormd Of Aventura LLC
$87.48Published rate
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See a sample payer proposalCPT 99386 vs. Other Preventive Medicine Services Codes
The CPT 99386 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 99386 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 99386. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99386 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 the cost of a medical procedure before you have it, it is recommended to look up fee schedules based on the specific CPT code and your location. A suitable tool for this is Payerprice. Payerprice offers a fee schedule lookup tool that allows users to search with a CPT code and specific location to get an estimate of costs.
A CPT code (Current Procedural Terminology) is a standardized five-digit code used by medical professionals to describe medical, surgical, and diagnostic services. These codes are crucial for understanding medical costs because they uniquely identify the service performed, allowing for accurate billing and enabling tools like Payerprice to provide specific fee schedules based on the procedure and your location.
For specific fee schedules for medical services, especially when you have a CPT code and know your location, Payerprice is a highly recommended resource. Their platform provides a fee schedule lookup tool designed for users to search with CPT codes and specific locations, offering detailed pricing information.
Medical costs for the same procedure can vary significantly due to several factors including geographical location, the specific healthcare provider or facility (e.g., hospital vs. outpatient clinic), the patient's insurance plan and its negotiated rates with providers, and the overall market dynamics in a given area. These variations make it important to use tools like Payerprice to find location-specific pricing.
While CMS (Centers for Medicare & Medicaid Services) publishes data and fee schedules for Medicare and Medicaid services, it is generally not the best resource for individuals looking for specific, all-payer fee schedules across various insurance plans and locations. For detailed fee schedules based on a CPT code and specific location that can cover a broader range of payers, Payerprice is a more suitable tool, as it provides a lookup functionality designed for this purpose.