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 | Moderate |
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 | $166.21 | 1225211600 - JOHN MILLICHAP | 731310891 - WARREN CLINIC INC | CO | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 99397 | $238.21 | 1194786517 - FELIX ACHOLONU | 590624449 - (FL) ST VINCENTS MEDICAL CENTER INC | FL | Obstetrics & Gynecology Physician (207V00000X) |
United | 99397 | $196.35 | 1316142383 - DIANE MISCH | 376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS | IL | Psychiatry Physician (2084P0800X) |
United | 99397 | $320.07 | 1447525647 - HOLLI JAKALOW | 135598093 - COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK | NY | Obstetrics & Gynecology Physician (207V00000X) |
United | 99397 | $123.00 | 1801813266 - GREGG BEAN | 741586031 | TX | Diagnostic Radiology Physician (2085R0202X) |
United | 99397 | $196.35 | 1720547672 - PERRY TSAI | 376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS | IL | Psychiatry Physician (2084P0800X) |
United | 99397 | $156.10 | 1760419311 - PETER HEYDEMANN | 366006541 - (IL) VETERANS ASSISTANCE COMMISSION C | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 99397 | $173.46 | 1578555256 - VIKTORIA ERHARDT | 363317058 - (IL) ACCESS COMMUNITY HEALTH NETWORK | IL | Psychiatry Physician (2084P0800X) |
United | 99397 | $156.10 | 1144476136 - STEVE PASCHOS | 366006541 - (IL) VETERANS ASSISTANCE COMMISSION C | IL | Psychiatry Physician (2084P0800X) |
United | 99397 | $255.88 | 1932130325 - ELIZABETH BERRY-KRAVIS | 911780160 | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 99397 | $280.79 | 1225211600 - JOHN MILLICHAP | 260899565 - MERCY SPECIALTY CLINIC | NC | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 99397 | $255.88 | 1730246067 - SENADA BAJMAKOVIC-KACILA | 911780160 | IL | Psychiatry Physician (2084P0800X) |
United | 99397 | $132.53 | 1548366263 - NARSIMHA MUDDASANI | 371305510 - TOUCHETTE REGIONAL HOSPITAL INC | IL | Psychiatry Physician (2084P0800X) |
United | 99397 | $214.19 | 1962431726 - MARTINS ADEOYE | 432081789 | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 99397 | $312.83 | 1316325038 - CAROLYN SMITH LIN | 208488778 - UNM MEDICAL GROUP INC | NM | 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 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 | 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 |
| 99387 | 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 | 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.
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