CPT 99396 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 99396 by major payers:
$142.82
$147.32
$146.27
$188.92
| 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 99396 | ||||||
United | 99396 | $100.80 | 1518996313 - CONSULTORIO MEDICO LATINO MEDICAL CENTER | 954467085 - (CA) CONSULTORIO MEDICO LATINO MEDICAL CENTER, INC. | CA | Family Medicine Physician (207Q00000X) |
United | 99396 | $134.61 | 1518982776 - ROBERT WEINER | 135562308 - NEW YORK UNIVERSITY | NY | Hematology & Oncology Physician (207RH0003X) |
United | 99396 | $144.61 | 1508893868 - ABBY LETCHER | 844777167 - (PA) VALLEY HEALTH PARTNERS COMMUNITY HEALTH CENTER | PA | Family Medicine Physician (207Q00000X) |
United | 99396 | $309.60 | 1336132562 - ONCOLOGY HEMATOLOGY CARE, INC. | 311106418 - ONCOLOGY/HEMATOLOGY CARE, INC. | OH | Hematology & Oncology Physician (207RH0003X) |
United | 99396 | $80.26 | 1669998415 - CLEAR LAKE WOUND CARE PLLC | 821837559 - (TX) CLEAR LAKE WOUND CARE PLLC | TX | Family Medicine Physician (207Q00000X) |
United | 99396 | $110.52 | 1700363892 - ZAID AL-SAHELI | 451674932 - (MI) MICHIGAN HEALTHCARE PROFESSIONALS, P.C. | MI | Hematology & Oncology Physician (207RH0003X) |
United | 99396 | $91.58 | 1598814634 - PACIFIC SHORES MEDICAL GROUP, INC | 330553940 - (CA) PACIFIC SHORES MEDICAL GROUP | CA | Hematology & Oncology Physician (207RH0003X) |
United | 99396 | $261.02 | 1679829832 - VASUNDHARA SINGH | 611661781 | NY | Hospitalist Physician (208M00000X) |
United | 99396 | $172.78 | 1194188367 - BENJAMIN SCHWARTZ | 834425637 - (AZ) ARIZONA BLOOD AND CANCER SPECIALISTS PLLC | AZ | Hematology & Oncology Physician (207RH0003X) |
United | 99396 | $655.53 | 1245766989 - ELYSIA CHIN | 954373071 | CA | Family Medicine Physician (207Q00000X) |
United | 99396 | $104.40 | 1134220544 - EDWIN YU | 954725558 - (CA) ACCESS MEDICAL CARE A PROFESSIONAL MEDICAL CORPORATION | CA | Family Medicine Physician (207Q00000X) |
United | 99396 | $114.12 | 1861586430 - JOHN STARKEY | 742501959 - (TX) TEXAS HEALTH CENTER, PA | TX | Family Medicine Physician (207Q00000X) |
United | 99396 | $148.96 | 1285839944 - IRENE ROTHMAN | 135562308 - NEW YORK UNIVERSITY | NY | Medical Physician Assistant (363AM0700X) |
United | 99396 | $219.88 | 1982225488 - AMANDA WEINBERG | 453023019 - NORTH SHORE-LIJ MEDICAL PC | NY | Physician Assistant (363A00000X) |
United | 99396 | $174.99 | 1922443431 - LUKE O'DONNELL | 135562308 - NEW YORK UNIVERSITY | NY | Hospitalist Physician (208M00000X) |
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 99396 vs. Other Preventive Medicine Services Codes
The CPT 99396 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 99396 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 |
|---|---|---|
| 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 |
| 99387-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; 65 Years And Over |
| 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) |
| 99396-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 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 99396. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99396 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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