CPT 99394 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 99394 by major payers:
$134.07
$134.64
$136.23
$173.76
| 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 99394 | ||||||
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 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 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 | 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) |
| 99385-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; 18-39 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) |
| 99394-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; Adolescent (Age 12 Through17 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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