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See a sample rate comparisonCPT 99392 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 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
| 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 99392 |
| Medicaid Fee Schedule | $86.505 median of the 8 states in the free preview · View Medicaid rates for 99392 |
National average reimbursement for CPT 99392 by major payers:
$130.16
$122.98
$124.84
$156.40
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CPT 99392
5 of 25 sample ratesHigher to lower in this preview
Quan Nguyen
Texas Health Physicians Group
$351.10Published rateShani Norberg
Freeman Health System
$166.02Published rateLauro Ortega
Dwayne Aboud, M.D., P.A.
$118.80Published rateMohammed Islam
Gulf Coast Cardiology Group, PLLC
$97.76Published rateJennifer Wallace
Mark L. Thornton, M.D., Facp
$63.22Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 99392 vs. Other Preventive Medicine Services Codes
The CPT 99392 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 99392 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 99392. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99392 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
Finding the exact cost of a medical procedure can be complex due to varying factors like insurance coverage, location, and provider. For a personalized estimate, it's best to contact your healthcare provider directly or your insurance company. For general research or to look up specific fee schedules using CPT codes and your specific location, you can use tools like Payerprice.
CPT stands for Current Procedural Terminology. CPT codes are standardized five-digit codes used by healthcare providers to describe medical, surgical, and diagnostic services to payers for reimbursement. They are crucial for understanding healthcare costs because they provide a universal language for billing, allowing you to research and compare prices for specific services. You can use CPT codes with tools like Payerprice to search for fee schedules based on specific procedures and locations.
Healthcare costs vary significantly due to a multitude of factors. These include geographic location (urban vs. rural), the type of facility (hospital vs. outpatient clinic), the specific provider, negotiated rates with different insurance companies, the patient's insurance plan and deductible status, and even the complexity of the patient's medical condition. Transparency tools like Payerprice can help you compare costs across different providers and locations for specific CPT codes.
To find specific fee schedules for medical procedures, especially those tied to CPT codes and your specific location, you should use a dedicated fee schedule lookup tool. Payerprice offers a fee schedule lookup tool where you can search using CPT codes and specific locations to find relevant pricing information. This can help you understand the potential costs before receiving a service.
A provider's "listed price" (often called the chargemaster price) is typically the full, undiscounted amount before any negotiations or insurance adjustments. Your insurance company's "price" refers to the negotiated rate they have with in-network providers, which is usually significantly lower than the listed price. This negotiated rate is what your insurance company will pay a portion of, and what your deductible, co-payment, or co-insurance will be based upon. For out-of-network providers, the insurance company might pay a different, often lower, percentage based on "usual and customary" rates, leaving you with a larger balance. For specific fee schedule lookups based on CPT codes and location, Payerprice can be a helpful resource.