CPT 99393 Fee Schedule
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.
| Key Fact | Detail |
|---|---|
| Service Type | • Evaluation and Management • Preventive Medicine Services |
| Common Place of Service | • 11 - Office • 50 - Federally Qualified Health Center |
| Common Modifiers | • None • 25 - Significant, separately identifiable E/M service same day • EP - Residential facility to Physician's office |
| Complexity Level | Low |
National average reimbursement for CPT 99393 by major payers:
$124.04
$122.53
$124.10
$157.80
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 99393 | ||||||
United | 99393 | $161.78 | 1922119890 - BRIAN VAILLANT | 264562522 - SETON FAMILY OF DOCTORS | TX | Neurology Physician (2084N0400X) |
United | 99393 | $90.38 | 1407176159 - PRASANNA MARPU | 273396768 - (TX) ELITE PATIENT CARE, PLLC | TX | Internal Medicine Physician (207R00000X) |
United | 99393 | $122.94 | 1811918766 - NATHANIEL GRIFFITH | 470971588 - (TX) NATHANIEL GRIFFITH DO PA | TX | Internal Medicine Physician (207R00000X) |
United | 99393 | $119.09 | 1700915303 - MADHAVA AGUSALA | 752736515 - (TX) MADHAVA AGUSALA MDPA | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99393 | $267.64 | 1861540551 - RACHEL BONNEMA | 756002868 | TX | Internal Medicine Physician (207R00000X) |
United | 99393 | $81.19 | 1437490414 - DIAZ HOSPITALIST GROUP PLLC | 462260000 - (TX) DIAZ HOSPITALIST GROUP PLLC | TX | Internal Medicine Physician (207R00000X) |
United | 99393 | $161.72 | 1134652936 - NICHOLAS BASTIAN | 742109824 - (TX) AUSTIN REGIONAL CLINIC PA | TX | Internal Medicine Physician (207R00000X) |
United | 99393 | $97.30 | 1801061643 - FRANCISCA GUSHIKEN | 475300786 - (TX) INPATIENT PROGRESSIVE HEALTHCARE OF AMERICA | TX | Internal Medicine Physician (207R00000X) |
United | 99393 | $142.91 | 1811987670 - MICHAEL TOBES | 465720165 - (TX) ALIGNED PROVIDERS OF EAST TEXAS | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99393 | $159.50 | 1770550311 - KENNETH MCCLURE | 204791426 | TX | Internal Medicine Physician (207R00000X) |
United | 99393 | $92.20 | 1174510507 - MIGUEL AYALA | 742574229 - (TX) WELLMED MEDICAL GROUP, P.A. | TX | Internal Medicine Physician (207R00000X) |
United | 99393 | $86.62 | 1407911969 - ROBERT MORRISON | 550853118 - CENTRAL TEXAS COMMUNITY HEALTH CENTERS | TX | Internal Medicine Physician (207R00000X) |
United | 99393 | $163.27 | 1154646560 - BENYAM ALEMU | 264562522 - SETON FAMILY OF DOCTORS | TX | Internal Medicine Physician (207R00000X) |
United | 99393 | $86.62 | 1225227499 - JOEL WOLINSKY | 455196386 - (TX) RANGER NEUROPHYSIOLOGY PA | TX | Neurology Physician (2084N0400X) |
United | 99393 | $161.72 | 1720060932 - MINI GOPALAN | 742109824 - (TX) AUSTIN REGIONAL CLINIC PA | TX | Internal Medicine Physician (207R00000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 99393 vs. Other Preventive Medicine Services Codes
The CPT 99393 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 99393 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 | 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 | 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/ Laboratory/Diagnostic Procedures New Patient; Adolescent (Age 12 Through 17 Years) |
| 99392-CPT | Low | 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 Laboratorylaboratory/Diagnostic Procedures Established Established Patient; Early Childhood (Age 1 Thr Ough 4 Years) |
| 99393-CPT | Low | 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 Laboratorylaboratory/Diagnostic Procedures Established Patient; Late Childhood (Age 5 Thro Ugh 11 Years) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99393. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99393 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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