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See a sample rate comparisonCPT 99395 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.
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
| 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 SA |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 99395 |
| Medicaid Fee Schedule | $96.24 median of the 8 states in the free preview · View Medicaid rates for 99395 |
National average reimbursement for CPT 99395 by major payers:
$135.57
$137.37
$137.39
$174.11
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CPT 99395
5 of 25 sample ratesHigher to lower in this preview
John Wust
Allina Health System
$371.08Published rateMauricio Bitran
Vitalmd Group Holding, LLC
$228.11Published rateAntonio Castellvi
Baycare Medical Group Inc
$169.89Published ratePreston Hatlestad
Bluestone Physician Services Southeast LLC
$106.73Published rateMark Akers
Mark Akers Md Inc
$85.38Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 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 |
|---|---|---|
| 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 |
| 99397-CPT | Low | Preventive Medical Care, Periodic Comprehensive Preventive Medicine Reevaluation And Management Of An Individual Including Age And Gender Appropriate History Examination Counseling/Anticipatory Guidance/Risk Factor Reduction Interventions And The Ordering Or Appropriate Immunization(S) Laboratory/Diagnostic Procedures Established Patient; 65 Years And Over |
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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Frequently Asked Questions
Medicare and Medicaid rates are primarily government-set reimbursement amounts. These rates are determined by a complex interplay of federal and state legislation, annual budget allocations, economic conditions, and national healthcare cost trends. For Medicare, the Centers for Medicare & Medicaid Services (CMS) establishes these rates, often based on fee schedules, diagnosis-related groups (DRGs), or relative value units (RVUs). Medicaid rates are set by individual states, often with federal matching funds and broad federal guidelines, leading to variations across states. Unlike private insurance, these rates are generally non-negotiable by healthcare providers.
Private insurance rates are the result of negotiations between healthcare providers (hospitals, clinics, individual practitioners) and private insurance companies. Many factors influence these negotiated rates, including the provider's reputation and quality of care, the volume of services they provide, their geographic location, the level of competition in the local healthcare market, and the specific insurance plan's network size and patient volume. The bargaining power of both the provider and the insurance company plays a crucial role. These rates are highly variable, meaning the cost for the same service can differ significantly depending on the insurance company, the specific plan, and the provider. If you are looking for specific rates for a particular CPT code in your location, you can use Payerprice's fee schedule lookup tool to get an estimate.