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See a sample rate comparisonCPT 99396 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 Ordering Of Appropriate Immunizations(S) Laboratory/Diagnostic Procedures Established Patient; 40-64 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 99396 |
| Medicaid Fee Schedule | $101.93 median of the 8 states in the free preview · View Medicaid rates for 99396 |
National average reimbursement for CPT 99396 by major payers:
$142.82
$147.32
$146.27
$186.19
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CPT 99396
5 of 25 sample ratesHigher to lower in this preview
Elysia Chin
$655.53Published rateAmanda Weinberg
North Shore-Lij Medical PC
$219.88Published rateTravis Bryan
$155.89Published rateJohn Starkey
Texas Health Center, PA
$114.12Published rateClear Lake Wound Care PLLC
$80.26Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 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 |
|---|---|---|
| 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 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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Frequently Asked Questions
CPT stands for Current Procedural Terminology. CPT codes are standardized numerical codes used by healthcare providers to describe medical, surgical, and diagnostic services to payers for accurate billing and reimbursement.
To find out the specific cost of a medical procedure, you should look up the CPT code for the service. Healthcare costs can vary significantly based on your location, provider, and insurance plan. For precise pricing information based on CPT code and specific location, you can use tools like Payerprice's fee schedule lookup tool.
Healthcare costs vary due to a multitude of factors, including the type of service, geographic location, specific healthcare provider (hospital vs. private practice), the negotiated rates with different insurance companies, and whether the provider is in-network or out-of-network. Different facilities also have different operating costs and pricing strategies.
A fee schedule is a complete listing of fees used by healthcare providers and insurance companies to determine the payment for medical services. It outlines the maximum reimbursement amount for each specific CPT code or service. These schedules are often negotiated between payers and providers.
Payerprice provides a fee schedule lookup tool that allows users to search for healthcare procedure costs using CPT codes and specific locations. This can help you understand the potential costs of medical services before they are rendered, aiding in financial planning and transparency.