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CPT 99394 Fee Schedule

Last Verified: July 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 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

Key Fact	Detail
Service Type	Established Patient 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
Medicare Fee Schedule	View Medicare rates for 99394

National average reimbursement for CPT 99394 by major payers:

$134.07

$134.64

$136.23

$170.71

Preview provider-level rates for...

For billing codeCPT 99394

Payer	Code	Rate	NPI	Tax ID	State	Specialty
United	99394	$102.00	1356870695 - PATRICIA FOLDEN	271529543 - (AZ) INNOVATIVE HEALTH CARE OF HAVASU LLC	AZ	Family Nurse Practitioner (363LF0000X)
United	99394	$95.12	1932449055 - KELLEE RANDLE	800725733 - (TX) HNI MEDICAL SERVICES	TX	Internal Medicine Physician (207R00000X)
United	99394	$102.30	1013279348 - TARA GRIFFIN	873711050 - MINGHSUN LIU MD PC	AZ	Physician Assistant (363A00000X)
United	99394	$98.69	1851497952 - LINDA WROTEN P.C., SW GERIATRICS	752720593 - (AZ) LINDA WROTEN PC	AZ	Nurse Practitioner (363L00000X)
United	99394	$141.69	1427797604 - CARLY LASURE	452464437	AZ	Physician Assistant (363A00000X)
United	99394	$169.58	1912417577 - JEAN MARSEILLE	901116753	AZ	Family Nurse Practitioner (363LF0000X)
United	99394	$134.22	1245226950 - DONALD NICHOLAS	752407455 - (TX) DONALD G NICHOLAS JR M D	TX	Internal Medicine Physician (207R00000X)
United	99394	$109.69	1770019721 - EVELYN LOZOYA	900730387	AZ	Family Nurse Practitioner (363LF0000X)
United	99394	$95.45	1508549452 - CHERYL ROBUCK	860296211 - (AZ) SUN LIFE FAMILY HEALTH CENTER INC	AZ	Family Nurse Practitioner (363LF0000X)
United	99394	$101.98	1073817896 - ROBERT ALEXANDER	861004478 - (AZ) ALL STAR HEALTH	AZ	Family Nurse Practitioner (363LF0000X)
United	99394	$93.48	1922632975 - HEIDI PARKER	200552815 - (AZ) EAST VALLEY CENTER FOR PULMONARY & SLEEP DISORDERS, INC.	AZ	Nurse Practitioner (363L00000X)
United	99394	$212.44	1285074682 - ABRAHAM CAMPOY	203059260 - BHS PHYSICIANS NETWORK, INC	TX	Internal Medicine Physician (207R00000X)
United	99394	$82.55	1750348108 - KARAH NORTON	870699281 - (AZ) KENNETH D. OSORIO, MD, PLLC	AZ	Adult Health Nurse Practitioner (363LA2200X)
United	99394	$95.27	1255335501 - MAYANK PARIKH	760687469 - (TX) FORT BEND CARDIOLOGY, P.A.	TX	Cardiovascular Disease Physician (207RC0000X)
United	99394	$95.69	1154999126 - CASIE VINSON	462389117 - (AZ) INTEGRITY PAIN AND ANESTHESIA PLLC DBA INTEGRITY PAIN AND WELLNESS	AZ	Family Nurse Practitioner (363LF0000X)
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 99394 vs. Other Preventive Medicine Services Codes

The CPT 99394 code is part of the Established Patient 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 99394 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
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 99394. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 99394 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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