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See a sample rate comparisonCPT 99397 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 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
| Key Fact | Detail |
|---|---|
| Service Type | Evaluation and Management Preventive Medicine Services |
| Common Place of Service | 11 - Office 19 - Off Campus Outpatient Hospital |
| Common Modifiers | 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 |
| Medicaid Fee Schedule | $110.07 median of the 8 states in the free preview · View Medicaid rates for 99397 |
National average reimbursement for CPT 99397 by major payers:
$143.64
$139.67
$131.80
$200.36
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CPT 99397
5 of 25 sample ratesHigher to lower in this preview
Amber Whited-Watson
Peacehealth Southwest Medical Center
$383.14Published rateChidinma Amakiri
Texas Health Physicians Group
$267.39Published rateJohanna Busch
$164.50Published rateFrancisco Garabis
Garabis Family Medicine LLC
$120.23Published rateDhiren Shah
Cardiology Consultants Of North Dallas, P.A.
$89.87Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 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 | Prev Visit New Age 18 39, 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 Diagnostic Procedures New Patient 18 39 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 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.
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Frequently Asked Questions
Factors that affect CPT 99397 fee schedules include 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), and Provider Type (hospital providers may have different rates than private practice).
CPT 99397 is part of the Evaluation and Management services for Preventive Medicine. It represents a moderate-complexity encounter, requiring more provider time and moderate medical decision-making compared to lower-level codes. It often involves multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation.
The national average reimbursement for CPT 99397 by major payers ranges from $131.80 (Aetna) to $174.39 (BCBS / Anthem), with United at $143.64 and Cigna at $139.67.
With PayerPrice, you can renegotiate your managed care contracts by benchmarking current rates, prospect for new business using fee schedules, and integrate real-time payer data into your workflows via API or SQL.