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See a sample rate comparisonCPT 99401 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 Medicine Counseling, Preventive Medicine Counseling Andor Risk Factor Reduction Intervention(S) Provided To An Individual (Separate Procedure) Approximately 15 Minutes
| Key Fact | Detail |
|---|---|
| Service Type | Evaluation and Management Preventive Medicine Services |
| Common Place of Service | 11 - Office 20 - Urgent Care Facility |
| Common Modifiers | 25 - Significant, separately identifiable E/M service same day 95 - Telemedicine - audio and video |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 99401 |
| Medicaid Fee Schedule | $32.645 median of the 8 states in the free preview · View Medicaid rates for 99401 |
National average reimbursement for CPT 99401 by major payers:
$44.48
$47.08
$46.68
$57.89
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CPT 99401
5 of 25 sample ratesHigher to lower in this preview
Phuong Trinh
Texas Health Physicians Group
$130.63Published rateRon Tintner
Freeman Health System
$61.13Published rateBrainwaves Neurology PLLC
$42.43Published rateMurtaza Mazhar
Abdul Memon Md PLLC
$33.59Published ratePramod Pinnamaneni
Lufkin Physician Services PA
$26.89Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 99401 vs. Other Preventive Medicine Services Codes
The CPT 99401 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 99401 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 |
|---|---|---|
| 99401-CPT | Low | Preventive Medicine Counseling, Preventive Medicine Counseling Andor Risk Factor Reduction Intervention(S) Provided To An Individual (Separate Procedure) Approximately 15 Minutes |
| 99402-CPT | Low | Preventive Medicine Counseling, Preventive Medicine Counseling Andor Risk Factor Reduction Intervention(S) Provided To An Individual (Separate Procedure) Approximately 30 Minutes |
| 99403-CPT | Low | Preventive Medicine Counseling, Preventive Medicine Counseling Andor Risk Factor Reduction Intervention(S) Provided To An Individual (Separate Procedure) Approximately 45 Minutes |
| 99404-CPT | Low | Preventive Medicine Counseling, Preventive Medicine Counseling Andor Risk Factor Reduction Intervention(S) Provided To An Individual (Separate Procedure) Approximately 60 Minutes |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99401. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99401 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 99401 is a Current Procedural Terminology code used for preventive medicine counseling and/or risk factor reduction interventions. It is typically for services provided to an individual for approximately 15 minutes and addresses moderate-level medical decision-making. Healthcare providers use this code for documentation and reimbursement.
Factors influencing CPT 99401 fee schedules include the type of payer (such as Medicare, Medicaid, or private insurance), the specific geographic location, and the type of provider (e.g., hospital versus private practice). These variations arise due to differing negotiated contracts and government-set reimbursement amounts. To find specific rates for your situation, you can use PayerPrice's fee schedule lookup tool.
CPT 99401 is categorized under Evaluation and Management services for Preventive Medicine Services. It signifies a moderate-complexity encounter requiring about 15 minutes of provider time. Other related codes, such as 99402, 99403, and 99404, represent progressively longer intervention times (30, 45, and 60 minutes, respectively), reflecting varying levels of complexity and reimbursement.
PayerPrice offers access to exact negotiated rates that insurers publicly disclose under federal transparency regulations. It assists users in benchmarking current rates, identifying new business opportunities by leveraging fee schedules, and integrating real-time payer data into their workflows for codes like CPT 99401.