CPT 99395 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 • SA |
| Complexity Level | Low |
National average reimbursement for CPT 99395 by major payers:
$135.57
$137.37
$137.39
$176.78
| 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 99395 | ||||||
United | 99395 | $371.08 | 1366443707 - JOHN WUST | 363261413 - ALLINA HEALTH SYSTEM | MN | Obstetrics & Gynecology Physician (207V00000X) |
United | 99395 | $92.86 | 1801835202 - CHICAGO NEUROLOGY GROUP SC | 113666848 - (IL) CHICAGO NEUROLOGY GROUP, S.C. | IL | Psychiatry Physician (2084P0800X) |
United | 99395 | $98.44 | 1174840516 - MELISSA GROVES | 132828349 - SUN RIVER HEALTH INC | NY | Obstetrics & Gynecology Physician (207V00000X) |
United | 99395 | $121.98 | 1144647207 - ANDREW KEASTER | 201891777 | OH | Internal Medicine Physician (207R00000X) |
United | 99395 | $219.22 | 1841264660 - BRIAN THOMPSON | 161478978 - UNIVERSITY OB-GYN ASSOCIATES INC | NY | Obstetrics & Gynecology Physician (207V00000X) |
United | 99395 | $169.89 | 1982233938 - TISHA VAN PELT | 593140335 - BAYCARE MEDICAL GROUP INC | FL | Family Medicine Physician (207Q00000X) |
United | 99395 | $107.66 | 1841263589 - JAMES BOWLUS | 341435892 | OH | Family Medicine Physician (207Q00000X) |
United | 99395 | $333.00 | 1093880171 - NICOLE HONG | 770465765 | CA | Obstetrics & Gynecology Physician (207V00000X) |
United | 99395 | $240.57 | 1912083676 - GENEVIEVE PAGALILAUAN | 911220843 - ASSOCIATION OF UNIVERSITY PHYSICIANS | WA | Internal Medicine Physician (207R00000X) |
United | 99395 | $169.89 | 1700114527 - ANTONIO CASTELLVI | 593140335 - BAYCARE MEDICAL GROUP INC | FL | Family Medicine Physician (207Q00000X) |
United | 99395 | $86.55 | 1376501031 - MARTHA FORD | 742797745 | FL | Family Medicine Physician (207Q00000X) |
United | 99395 | $250.66 | 1134578222 - CAROL HUNGERFORD | 910214500 - THE EVERETT CLINIC, PLLC | WA | Family Medicine Physician (207Q00000X) |
United | 99395 | $250.22 | 1831335850 - CLAUDINE SINSIOCO | 540620889 - INOVA HEALTH CARE SERVICES | IL | Psychiatry Physician (2084P0800X) |
United | 99395 | $194.88 | 1003888090 - SAMAR HIJAZI | 311007881 - MERCY HEALTH PHYSICIANS CINCINNATI LLC | OH | Internal Medicine Physician (207R00000X) |
United | 99395 | $196.66 | 1871563452 - FREDERICK SILFEN | 205733575 | FL | Obstetrics & Gynecology Physician (207V00000X) |
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 99395 vs. Other Preventive Medicine Services Codes
The CPT 99395 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 99395 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 |
|---|---|---|
| 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 |
| 99386-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; 40-64 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) |
| 99395-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 Laboratorydiagnostic 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 99395. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99395 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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