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See a sample rate comparisonCPT 99391 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.
Per Pm Reeval Est Pat Infant, Periodic Comprehensive Preventive Medicine Reevaluation 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 Established Patient Infant Age Younger Than 1 Year
| 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 99391 |
| Medicaid Fee Schedule | $81.44 median of the 8 states in the free preview · View Medicaid rates for 99391 |
National average reimbursement for CPT 99391 by major payers:
$119.79
$114.19
$116.45
$145.70
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CPT 99391
5 of 25 sample ratesHigher to lower in this preview
Tsan Chun Lee
Multicare Health System
$211.44Published rateRinkal Patel
Texas Health Care, P.L.L.C.
$129.91Published rateStep By Step Pediatrics
Step By Step Pediatrics LLC
$90.55Published rateYelena Krupnik
$78.00Published rateRosa Lopez
$47.93Published rate
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See a sample payer proposalCPT 99391 vs. Other Preventive Medicine Services Codes
The CPT 99391 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 99391 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 |
|---|---|---|
| 99391-CPT | Low | Per Pm Reeval Est Pat Infant, Periodic Comprehensive Preventive Medicine Reevaluation 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 Established Patient Infant Age Younger Than 1 Year |
| 99392-CPT | Low | Prev Visit Est Age 1 4, Periodic Comprehensive Preventive Medicine Reevaluation 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 Established Patient Early Childhood Age 1 Through 4 Years |
| 99393-CPT | Low | Prev Visit Est Age 5 11, Periodic Comprehensive Preventive Medicine Reevaluation 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 Established Patient Late Childhood Age 5 Through 11 Years |
| 99394-CPT | Low | Prev Visit Est Age 12 17, Periodic Comprehensive Preventive Medicine Reevaluation 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 Established 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 99391. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99391 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
CPT stands for Current Procedural Terminology. These are a set of codes used by healthcare providers to describe medical, surgical, and diagnostic services to payers for reimbursement. Each CPT code represents a specific service or procedure.
You can often find estimated costs for medical procedures by using online tools that allow you to search based on CPT codes and your specific location. For accurate and up-to-date fee schedule information, you can use services like Payerprice. It's also advisable to contact your healthcare provider and insurance company directly for the most precise cost estimates tailored to your plan.
To look up healthcare prices for a specific service in your area using a CPT code, you can utilize tools like Payerprice. Payerprice offers a fee schedule lookup tool that allows users to search with a CPT code and specific location to get relevant pricing information.
The cost of a medical service can be influenced by several factors, including the type of procedure, the healthcare provider or facility, your geographic location, your insurance plan and its specific benefits (deductibles, co-pays, coinsurance), and whether the service is in-network or out-of-network.
The price you see online is often an estimated fee schedule and may not be the final price you will pay. The actual cost can vary based on your specific insurance plan, deductibles, co-pays, coinsurance, and whether additional services are rendered during your visit. It's always best to verify with your insurance provider and healthcare facility for a personalized estimate.