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See a sample rate comparisonCPT 99394 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 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 | 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 99394 |
| Medicaid Fee Schedule | $94.375 median of the 8 states in the free preview · View Medicaid rates for 99394 |
National average reimbursement for CPT 99394 by major payers:
$134.07
$134.64
$136.23
$170.71
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CPT 99394
5 of 25 sample ratesHigher to lower in this preview
Blake Barker
$294.42Published rateJasmine Kalili
$133.36Published ratePatricia Folden
Innovative Health Care Of Havasu LLC
$102.00Published rateHayley Madler
Virtis Health LLC
$95.69Published rateKarah Norton
Kenneth D. Osorio, Md, PLLC
$82.55Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 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 |
|---|---|---|
| 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 |
| 99396-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 Ordering Of Appropriate Immunizations(S) Laboratory/Diagnostic Procedures Established Patient; 40-64 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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Frequently Asked Questions
CPT 99394 reports a periodic preventive medicine visit for an established patient aged 12 through 17, including an age-appropriate history, exam, counseling and anticipatory guidance.
A significant, separately identifiable problem addressed at the same visit can be billed with a problem oriented E/M code and modifier 25. Vaccines, screenings and lab tests are reported separately.
Medicare pays CPT 99394 under the Physician Fee Schedule. The non-facility rate applies when the service is done in an office and covers the practice's staff, supplies and equipment; the lower facility rate applies in a hospital or surgery center, which bills its own facility fee. Both are adjusted for the local cost of practice. Commercial payers negotiate their own rates, often as a percentage of Medicare, so the same code can pay very differently from one contract to the next.
This page lists the rates commercial payers have published for CPT 99394 in their Transparency in Coverage files, so you can compare payers and see where a contract falls. For government benchmarks, PayerPrice also has the Medicare fee schedule lookup and Medicaid fee schedules by state.