CPT 99401 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 • 20 - Urgent Care Facility |
| Common Modifiers | • None • 25 - Significant, separately identifiable E/M service same day • 95 - Telemedicine - audio and video |
| Complexity Level | Low |
National average reimbursement for CPT 99401 by major payers:
$44.48
$47.08
$46.68
$59.79
| 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 99401 | ||||||
United | 99401 | $87.26 | 1063953297 - AMNA RAMZAN | 930591528 - (OR) LEGACY MOUNT HOOD MEDICAL CENTER | TX | Neurology Physician (2084N0400X) |
United | 99401 | $32.86 | 1225396856 - ALLIED NEURODIAGNOSTIC SERVICES LLC | 454835389 - (TX) ALLIED NEURODIAGNOSTIC SERVICES | TX | Neurology Physician (2084N0400X) |
United | 99401 | $30.15 | 1740369354 - KENDALL WONG | 752742663 - KENDALL H. WONG, M.D. | TX | Internal Medicine Physician (207R00000X) |
United | 99401 | $42.13 | 1235490426 - TIGIST MEHARI | 111888924 - GOOD SAMARITAN HOSPTIAL MEDICAL CENTER | TX | Neurology Physician (2084N0400X) |
United | 99401 | $35.02 | 1396826855 - FEMI LAYIWOLA | 273479673 - (TX) DR. FEMI LAYIWOLA, M.D. P.A. DBA HOSPITALIST SOLUTIONS GROUP | TX | Internal Medicine Physician (207R00000X) |
United | 99401 | $38.63 | 1861620767 - NABEEL CHAUDHARY | 473898329 | TX | Internal Medicine Physician (207R00000X) |
United | 99401 | $42.36 | 1952741795 - LEON TIO | 820738699 - (TX) LEON S TIO MD PA | TX | Internal Medicine Physician (207R00000X) |
United | 99401 | $28.18 | 1972563286 - ALAN CARPENTER | 203897330 - (TX) UPPER VALLEY URGENT CARE CENTER, P.A. | TX | Internal Medicine Physician (207R00000X) |
United | 99401 | $32.34 | 1003874371 - EARL MANGIN | 741941710 | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99401 | $60.63 | 1982681466 - ANN RADCLIFFE | 741181532 - (TX) MEDICAL CLINIC OF HOUSTON, LLP | TX | Internal Medicine Physician (207R00000X) |
United | 99401 | $30.30 | 1255433611 - AUSTIN WILLIAMS | 10744731 - (TX) AUSTIN OSCAR WILLIAMS MD PA | TX | Internal Medicine Physician (207R00000X) |
United | 99401 | $77.66 | 1295729911 - SHALAUN HAWKINS | 863105304 - (TX) HILLCREST INTERNAL MEDICINE PLLC | TX | Internal Medicine Physician (207R00000X) |
United | 99401 | $61.43 | 1013440882 - LUNA LIU | 300520570 - (TX) METHODIST HOSPITAL | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99401 | $69.51 | 1760844765 - ZAYD NASHAAT | 464237992 | TX | Internal Medicine Physician (207R00000X) |
United | 99401 | $43.84 | 1689628885 - SUBODH MALLIK | 756001193 | 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 |
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CPT 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 And/Or Risk Factor Reduction Intervention(S) Provided To An Individu Al (Separate Procedure); Approximatelt 15 Minutes |
| 99402-CPT | Low | Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S) Provided To An Individual (Separate Procedure); Approximately 30 Minutes |
| 99403-CPT | Low | Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S) Provided To An Individual (Separate Procedure); Approximately 45 Minutes |
| 99404-CPT | Low | Preventive Medicine Counseling And/Or 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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