CPT 99402 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 • None |
| Common Modifiers | • None • 95 - Telemedicine - audio and video • 25 - Significant, separately identifiable E/M service same day |
| Complexity Level | Low |
National average reimbursement for CPT 99402 by major payers:
$75.94
$78.80
$77.82
$98.89
| 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 99402 | ||||||
United | 99402 | $103.48 | 1356788178 - CHARLES AMELEMAH | 845044935 - (TX) UNITY HOSPITALIST GROUP PLLC | TX | Internal Medicine Physician (207R00000X) |
United | 99402 | $60.09 | 1740451517 - MANUEL ESTRADA | 812460928 - (TX) MACIAS HEALTHCARE CLINIC PLLC | TX | Internal Medicine Physician (207R00000X) |
United | 99402 | $63.54 | 1528075348 - JOHN FOWLER | 741903407 - (TX) BEAUMONT INTERNAL MEDICINE & GERIATRIC ASSOCIATES | TX | Internal Medicine Physician (207R00000X) |
United | 99402 | $101.48 | 1700184231 - SASIKALA CHITTIMIREDDY | 300520570 - (TX) METHODIST HOSPITAL | TX | Internal Medicine Physician (207R00000X) |
United | 99402 | $104.16 | 1598778698 - ROBERT THOMPSON | 752536818 - HEALTHTEXAS PROVIDER NETWORK | TX | Internal Medicine Physician (207R00000X) |
United | 99402 | $90.80 | 1447381728 - VENKATESH NAGARADDI | 841343242 | TX | Neurology Physician (2084N0400X) |
United | 99402 | $90.02 | 1265095160 - MARCOS VILLARREAL | 262546097 - MARY WASHINGTON HEALTHCARE PHYSICIANS | TX | Internal Medicine Physician (207R00000X) |
United | 99402 | $165.05 | 1366703142 - JOSHUA LIAO | 756002868 | TX | Internal Medicine Physician (207R00000X) |
United | 99402 | $76.58 | 1679911952 - GABRIELA RANGEL | 746000756 - (TX) EL PASO COUNTY HOSPITAL DISTRICT | TX | Internal Medicine Physician (207R00000X) |
United | 99402 | $45.95 | 1750459236 - MANOJ VAKIL | 272022354 - (TX) TRUMEN PHYSICIANS AND ASSOCIATES PLLC | TX | Internal Medicine Physician (207R00000X) |
United | 99402 | $107.33 | 1649598285 - VIKAS PANDEY | 383852646 - OSF MULTI-SPECIALTY GROUP | TX | Neurology Physician (2084N0400X) |
United | 99402 | $73.51 | 1104387430 - SHA'RAY SHAW | 260592487 - (TX) SHETH MD PA | TX | Neurology Physician (2084N0400X) |
United | 99402 | $53.41 | 1891159349 - ROBERTO GONZALEZ | 843303610 - (TX) BORDERLAND PRIMARY CARE PA | TX | Internal Medicine Physician (207R00000X) |
United | 99402 | $51.15 | 1871593103 - SAURABH SINGH | 943417304 - (TX) JASPER DIAGNOSTIC CLINIC, P.A. | TX | Internal Medicine Physician (207R00000X) |
United | 99402 | $65.62 | 1326020405 - MOHAMMED PARVARI | 752379576 | 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 99402 vs. Other Preventive Medicine Services Codes
The CPT 99402 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 99402 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 99402. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99402 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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