CPT 99404 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 • 10 - Telehealth in Patient's Home |
| Common Modifiers | • None • 95 - Telemedicine - audio and video • 25 - Significant, separately identifiable E/M service same day |
| Complexity Level | Moderate |
National average reimbursement for CPT 99404 by major payers:
$132.11
$139.93
$132.52
$158.89
| 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 99404 | ||||||
United | 99404 | $40.00 | 1134710908 - CORA HEALTH SERVICES INC., CORA PHYSICAL THERAPY - MAGNOLIA | 341853567 - CORA HEALTH SERVICES, INC. | FL | Rehabilitation Clinic/Center (261QR0400X) |
United | 99404 | $40.00 | 1336631563 - CADY THERAPY SERVICE INC. | 474656921 - (FL) CADY THERAPY SERVICE INC | FL | Clinic/Center (261Q00000X) |
United | 99404 | $82.73 | 1013501113 - ALL INCLUSIVE PREVENTIVE CARE LLC | 853724514 - (FL) ALL INCLUSIVE PREVENTIVE CARE LLC | FL | Clinic/Center (261Q00000X) |
United | 99404 | $133.88 | 1962644807 - HSHS MEDICAL GROUP INC | 263956318 - (IL) HSHS MEDICAL GROUP INC | IL | Multi-Specialty Clinic/Center (261QM1300X) |
United | 99404 | $60.00 | 1609809870 - CORA HEALTH SERVICES INC, CORA REHABILITATION CLINICS - WINTER PARK | 341853567 - CORA HEALTH SERVICES, INC. | FL | Rehabilitation Clinic/Center (261QR0400X) |
United | 99404 | $148.83 | 1134236565 - WARREN KAMMERER | 611549647 - (IL) WARREN KAMMERER MD SC | IL | Psychiatry Physician (2084P0800X) |
United | 99404 | $67.31 | 1730135849 - CONVENIENT CARE MEDICAL CENTER INC | 223687218 - (FL) CONVENIENT CARE MEDICAL CENTER INC | FL | Clinic/Center (261Q00000X) |
United | 99404 | $85.05 | 1811633845 - CRYSTAL LANE | 822211607 - (MO) HONOUR BRITE LLC | FL | Psychiatric/Mental Health Nurse Practitioner (363LP0808X) |
United | 99404 | $202.36 | 1295021012 - FERNANDO SILVESTRE | 223316007 - BARNABAS HEALTH MEDICAL GROUP P C | FL | Psychiatry Physician (2084P0800X) |
United | 99404 | $177.50 | 1932650496 - ADVENTIST HEALTH PARTNERS, INC. | 371762682 - (IL) ADVENTIST MIDWEST HEALTH | IL | Multi-Specialty Clinic/Center (261QM1300X) |
United | 99404 | $201.05 | 1275618365 - STEPHANIE WINN | 581537752 - EMORY UNIVERSITY | GA | Psychiatry Physician (2084P0800X) |
United | 99404 | $220.19 | 1548279870 - VINOD ALLURI | 364015560 - LOYOLA UNIVERSITY MEDICAL CENTER | IL | Psychiatry Physician (2084P0800X) |
United | 99404 | $116.47 | 1275203424 - KRISTIE MURDOCK | 591664577 - PROJECT HEALTH INC | FL | Psychiatric/Mental Health Nurse Practitioner (363LP0808X) |
United | 99404 | $126.01 | 1629515234 - VERONICA O'CONNOR | 811482305 | NJ | Psychiatric/Mental Health Nurse Practitioner (363LP0808X) |
United | 99404 | $99.22 | 1407223258 - LATOYA ROBINSON | 844428649 - (IL) PERSPECTIVE BEHAVIORAL AND PAIN SOLUTIONS INC | IL | Psychiatric/Mental Health Nurse Practitioner (363LP0808X) |
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 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 | Low | Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S) Provided To An Individu Al (Separate Procedure); Approximatelt 15 Minutes |
| 99402 | Low | Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S) Provided To An Individual (Separate Procedure); Approximately 30 Minutes |
| 99403 | Low | Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S) Provided To An Individual (Separate Procedure); Approximately 45 Minutes |
| 99404 | 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 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.
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