CPT 99395 Fee Schedule

Last Verified: November 2025

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.

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

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	Moderate

National average reimbursement for CPT 99395 by major payers:

$135.57

$137.37

$137.39

$176.78

Preview provider-level rates for...

For billing codeCPT 99395

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	$113.30	1972502755 - ANDREW FOLLEY	760422435 - C H WILKINSON PHYSICIAN NETWORK	NV	Obstetrics & Gynecology Physician (207V00000X)
United	99395	$420.29	1093893828 - CAROL DARWISH	571205856	CA	Obstetrics & Gynecology Physician (207V00000X)
United	99395	$102.77	1457028573 - OB HOSPITALIST GROUP LLC	205648784 - OB HOSPITALIST GROUP, LLC	FL	Obstetrics & Gynecology Physician (207V00000X)
United	99395	$162.97	1952612665 - MEGHAN MEHL	341790929 - SUMMA HEALTH	OH	Obstetrics & Gynecology Physician (207V00000X)
United	99395	$231.53	1376832543 - SILKA PATEL	520595110 - JOHNS HOPKINS UNIVERSITY	MD	Obstetrics & Gynecology Physician (207V00000X)
United	99395	$82.23	1245409655 - DORIS RAMIREZ NESSETTI	470798717 - (FL) ALLCARE MEDICAL CENTERS	FL	Obstetrics & Gynecology Physician (207V00000X)
United	99395	$371.08	1366443707 - JOHN WUST	363261413 - ALLINA HEALTH SYSTEM	MN	Obstetrics & Gynecology Physician (207V00000X)
United	99395	$203.38	1639193600 - DAVID STEWART	260609255 - FLORIDA WOMAN CARE, LLC	FL	Obstetrics & Gynecology Physician (207V00000X)
United	99395	$348.26	1073740395 - JULIA CORMANO	237064656 - HEALING THE SOUL	IL	Obstetrics & Gynecology Physician (207V00000X)
United	99395	$250.66	1134578222 - CAROL HUNGERFORD	910214500 - THE EVERETT CLINIC, PLLC	WA	Family Medicine Physician (207Q00000X)
United	99395	$181.83	1275582660 - BEVERLY JOYCE	260089066	CA	Obstetrics & Gynecology Physician (207V00000X)
United	99395	$213.67	1447251418 - JAMES ROWLAND	251838458 - HIGHMARK HEALTH	PA	Obstetrics & Gynecology Physician (207V00000X)
United	99395	$196.66	1871563452 - FREDERICK SILFEN	205733575	FL	Obstetrics & Gynecology Physician (207V00000X)
United	99395	$108.50	1801813266 - GREGG BEAN	741586031	TX	Diagnostic Radiology Physician (2085R0202X)
United	99395	$239.96	1548364532 - GEORGE HEADING	61483728 - PHYSICIANS FOR WOMEN'S HEALTH, LLC	CT	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	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	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	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	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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