CPT 99397 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 • 19 - Off Campus Outpatient Hospital |
| Common Modifiers | • None • 25 - Significant, separately identifiable E/M service same day • GY - Notice of Liability Not Issued, Not Required Under Payer Policy. |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 99397 |
National average reimbursement for CPT 99397 by major payers:
$143.64
$139.67
$131.80
$174.39
| 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 99397 | ||||||
United | 99397 | $122.76 | 1033569611 - THE HEALTH EXPERIENCES PRIMARY CARE | 812763139 - (OH) THE HEALTH EXPERIENCES PRIMARY CARE | OH | Family Medicine Physician (207Q00000X) |
United | 99397 | $100.84 | 1457355083 - KENDRICK BASHOR | 384054260 - (OH) SLAINTEHEALTH LLC | OH | Family Medicine Physician (207Q00000X) |
United | 99397 | $312.83 | 1316325038 - CAROLYN SMITH LIN | 208488778 - UNM MEDICAL GROUP INC | NM | Obstetrics & Gynecology Physician (207V00000X) |
United | 99397 | $120.23 | 1992747240 - FRANCISCO GARABIS | 873093438 - (OH) GARABIS FAMILY MEDICINE LLC | OH | Family Medicine Physician (207Q00000X) |
United | 99397 | $180.77 | 1114504065 - SARAH FAIZI | 341768928 | OH | Family Medicine Physician (207Q00000X) |
United | 99397 | $115.55 | 1770539629 - FAMILY HEALTH CARE OF MARYSVILLE, LLC | 202119522 - (OH) FAMILY HEALTH CARE OF MARYSVILLE LLC | OH | Family Medicine Physician (207Q00000X) |
United | 99397 | $104.98 | 1477536258 - THOMAS LEHNER | 341926995 - (OH) LAKE ANNA PRIMARY CARE | OH | Family Medicine Physician (207Q00000X) |
United | 99397 | $345.26 | 1124027958 - GEORGE JOHN | 756002868 | TX | Internal Medicine Physician (207R00000X) |
United | 99397 | $383.14 | 1477700912 - AMBER WHITED-WATSON | 916068143 - PEACEHEALTH SOUTHWEST MEDICAL CENTER | OH | Family Medicine Physician (207Q00000X) |
United | 99397 | $167.60 | 1487865234 - MARC NADERER | 341933718 - NORTHERN OHIO MEDICAL SPECIALISTS, LLC | OH | Family Medicine Physician (207Q00000X) |
United | 99397 | $129.42 | 1710977913 - ROUSSEL CLEMENT | 463408401 - (TX) SOUTHEAST TEXAS INPATIENT PHYSICIAN ASSOCIATES | TX | Internal Medicine Physician (207R00000X) |
United | 99397 | $125.69 | 1245627785 - FAHAD NAJEEB MD PLLC | 473591410 - (TX) FAHAD NAJEEB MD PLLC | TX | Internal Medicine Physician (207R00000X) |
United | 99397 | $228.11 | 1790746279 - MARK GRENITZ | 542129332 - (FL) VITALMD GROUP HOLDING, LLC | FL | Obstetrics & Gynecology Physician (207V00000X) |
United | 99397 | $214.19 | 1962431726 - MARTINS ADEOYE | 432081789 | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 99397 | $267.39 | 1265729461 - ANDREA GIOMI | 752613493 - TEXAS HEALTH PHYSICIANS GROUP | TX | Internal Medicine Physician (207R00000X) |
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 |
Want to see your competitors' rates?
Start your trial today to unlock complete access to provider rates and fee schedules in your area.
Here's what you can do with PayerPrice
Renegotiate your managed care contracts
Benchmark your current rates against market averages to identify opportunities for rate optimization.
Prospect for new business using fee schedules
Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.
Integrate real-time payer data into your workflows
Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.
PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.
CPT 99397 vs. Other Preventive Medicine Services Codes
The CPT 99397 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 99397 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 |
| 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 |
| 99397-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; 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 99397. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99397 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.
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 99397) and we'll show you how you compare in 15 minutes or less.