Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonCPT 99404 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 60 Minutes
| Key Fact | Detail |
|---|---|
| Service Type | Evaluation and Management Preventive Medicine Services |
| Common Place of Service | 11 - Office 10 - Telehealth in Patient's Home |
| Common Modifiers | 95 - Telemedicine - audio and video 25 - Significant, separately identifiable E/M service same day |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 99404 |
| Medicaid Fee Schedule | $92.50 median of the 8 states in the free preview · View Medicaid rates for 99404 |
National average reimbursement for CPT 99404 by major payers:
$132.11
$139.93
$132.52
$126.62
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 99404.
CPT 99404
5 of 25 sample ratesHigher to lower in this preview
Anastasia Alvarado
Emory University
$284.11Published rateOlugbemiga Osoba
Henry Ford Health System
$185.91Published rateMadison Osteopathic Medicine
$122.31Published rateErin Krikie
Christopher Greater Area Rural Health Planning Corporation
$97.05Published rateCora Health Services Inc., Cora Physical Therapy - Fleming Island
Cora Health Services, Inc.
$35.00Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 99404 vs. Other Preventive Medicine Services Codes
The CPT 99404 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 99404 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 99404. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99404 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.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 99404) and we'll show you how you compare in 15 minutes or less.
Frequently Asked Questions
The cost of a medical procedure can vary significantly based on your location, the specific provider, and your insurance plan. To get an estimate, you can start by contacting your insurance company to understand your coverage and potential out-of-pocket costs. You can also ask your healthcare provider for an estimate before the procedure. For a more detailed lookup of fee schedules by CPT code and specific location, you can use tools like Payerprice.
CPT stands for 'Current Procedural Terminology.' CPT codes are standardized five-digit codes used by healthcare providers to describe medical, surgical, and diagnostic services to insurance companies and other payers. They are crucial for accurate billing and processing of claims, ensuring consistent communication about the services performed.
Insurance companies determine what they pay based on several factors, including their negotiated rates with providers, your specific plan's benefits, and your progress towards your deductible, copayments, and coinsurance. They typically have contracts with healthcare providers that set agreed-upon prices for services. Your out-of-pocket costs will depend on whether you've met your deductible, your copay for the visit, and the coinsurance percentage specified in your policy, up to your out-of-pocket maximum.
If you receive a medical bill that seems unusually high, the first step is to carefully review it for errors and compare it with the Explanation of Benefits (EOB) from your insurance company. Next, contact your healthcare provider's billing department to ask for an itemized bill and inquire about the charges. You should also contact your insurance company to understand why certain services may not have been covered as expected. Don't hesitate to negotiate the bill directly with the provider or seek assistance from patient advocacy groups if needed. For transparency on typical costs, remember you can use tools like Payerprice to research fee schedules by CPT code and location.
To find information about healthcare provider fees in your specific area, especially for particular procedures, you can utilize tools designed for price transparency. Payerprice offers a fee schedule lookup tool where you can search for costs using a CPT code and your specific location to get an understanding of typical charges.