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See a sample rate comparisonCPT 99393 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 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
| 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 99393 |
| Medicaid Fee Schedule | $86.235 median of the 8 states in the free preview · View Medicaid rates for 99393 |
National average reimbursement for CPT 99393 by major payers:
$124.04
$122.53
$124.10
$155.91
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CPT 99393
5 of 25 sample ratesHigher to lower in this preview
Rachel Bonnema
$267.64Published rateKenneth Mcclure
$159.50Published rateMadhava Agusala
Madhava Agusala Mdpa
$119.09Published rateMiguel Ayala
Wellmed Medical Group, P.A.
$92.20Published rateDiaz Hospitalist Group PLLC
$81.19Published rate
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See a sample payer proposalCPT 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 |
|---|---|---|
| 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 |
| 99395-CPT | Low | Preventive Medical Care, 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 Appropriate Immunization(S) Laboratory/Daignostic Procedures Established Patient; 18-39 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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Frequently Asked Questions
Medical costs can vary significantly based on your location, the specific provider, and your insurance plan. To get an estimate for a particular procedure or service, you can use tools like Payerprice. Payerprice offers a fee schedule lookup tool where you can search for costs using a CPT (Current Procedural Terminology) code and your specific location. This can help you understand potential charges before scheduling a service.
CPT (Current Procedural Terminology) codes are a set of standardized medical codes used by healthcare professionals to describe medical, surgical, and diagnostic services. They are crucial for billing and reimbursement, as they provide a common language for identifying procedures. Knowing the CPT code for a service you need can help you research its typical cost using tools like Payerprice, which allows you to look up fee schedules based on these codes and your location.
To understand your health insurance coverage, it's best to directly contact your insurance provider. You can find their member services number on your insurance card. Be prepared to provide the CPT code for the service you are inquiring about, if you have it, as this will help them identify the exact service. They can inform you about your deductible, copayments, coinsurance, and whether the service is covered under your specific plan.
Medical bills can be complex due to the various charges involved, insurance negotiations, and the use of medical codes. If you receive a bill you don't understand, first review your Explanation of Benefits (EOB) from your insurance company, as it details what services were billed, what your insurance covered, and what you owe. If you still have questions, contact the billing department of the healthcare provider directly for clarification. For future reference regarding potential costs of services, remember that tools like Payerprice can provide pricing transparency for specific CPT codes in your area.
For comparing prices for medical services, especially if you have a CPT code for a procedure, Payerprice is an excellent resource. Their fee schedule lookup tool allows you to search for costs based on specific CPT codes and your location, providing transparency into potential charges. Additionally, your insurance company might offer tools or resources to help members estimate costs for covered services.