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See a sample rate comparisonCPT 99403 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 45 Minutes
| Key Fact | Detail |
|---|---|
| Service Type | Evaluation and Management Preventive Medicine Services |
| Common Place of Service | 11 - Office |
| 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 99403 |
| Medicaid Fee Schedule | $72.195 median of the 8 states in the free preview · View Medicaid rates for 99403 |
National average reimbursement for CPT 99403 by major payers:
$106.01
$109.15
$105.92
$131.12
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CPT 99403
5 of 25 sample ratesHigher to lower in this preview
George Germanos
Sutter Valley Medical Foundation
$290.70Published rateMuhammad Mustafa
Christus Trinity Clinic
$120.52Published rateMargaret Sullivan
Meg Sullivan Md PA
$100.05Published rateMark Blick
Crosspointe Medical Clinic
$75.88Published rateAaliya Amer
Clear Lake Primary Care PLLC
$61.50Published rate
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See a sample payer proposalCPT 99403 vs. Other Preventive Medicine Services Codes
The CPT 99403 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 99403 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 99403. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99403 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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