CPT 99406 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 • 50 - Federally Qualified Health Center |
| Common Modifiers | • None • 25 - Significant, separately identifiable E/M service same day • 59 - Distinct Procedural Service |
| Complexity Level | Moderate |
National average reimbursement for CPT 99406 by major payers:
$16.97
$17.62
$17.89
$31.45
| 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 99406 | ||||||
United | 99406 | $35.45 | 1750593448 - MARSHA GUESS | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Female Pelvic Medicine and Reconstructive Surgery (Obstetrics & Gynecology) Physician (207VF0040X) |
United | 99406 | $28.55 | 1174255533 - CORTLAND VIS | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Physician Assistant (363A00000X) |
United | 99406 | $29.32 | 1700171733 - KARENA LAWRENCE | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Neonatal-Perinatal Medicine Physician (2080N0001X) |
United | 99406 | $36.40 | 1174574107 - STEPHEN DANIELS | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Pediatric Cardiology Physician (2080P0202X) |
United | 99406 | $28.55 | 1487171237 - ELHUM KARIMKHANI | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Adult Health Nurse Practitioner (363LA2200X) |
United | 99406 | $28.55 | 1275809279 - AMANDA MESSINGER | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | IL | Pediatric Pulmonology Physician (2080P0214X) |
United | 99406 | $28.55 | 1902247372 - ASHLEY ARKEMA | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | NY | Adult Health Nurse Practitioner (363LA2200X) |
United | 99406 | $35.45 | 1053843672 - CAITLIN BELL | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Cardiovascular Disease Physician (207RC0000X) |
United | 99406 | $9.68 | 1265097596 - JOHN CAMERON | 270492585 - (FL) CERTIFIED FOOT ANKLE SPECIALISTS | FL | Foot & Ankle Surgery Podiatrist (213ES0103X) |
United | 99406 | $28.55 | 1144300567 - LESLIE COKER APPIAH | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Gynecology Physician (207VG0400X) |
United | 99406 | $35.70 | 1386025302 - NICHOLAS HOLZEMER | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Advanced Heart Failure and Transplant Cardiology Physician (207RA0001X) |
United | 99406 | $27.94 | 1528521721 - JOSEPH THELEN | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Diagnostic Radiology Physician (2085R0202X) |
United | 99406 | $27.94 | 1669465894 - AMY BARLEY | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Nuclear Cardiology Physician (207UN0901X) |
United | 99406 | $35.45 | 1205259447 - ALEX HIROSE | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | VA | Physician Assistant (363A00000X) |
United | 99406 | $34.75 | 1932752508 - MITCHELL ERICKSON | 742161737 - UNIVERSITY PHYSICIANS INCORPORATED | CO | Surgical Physician Assistant (363AS0400X) |
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 99406 vs. Other Preventive Medicine Services Codes
The CPT 99406 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 99406 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 |
| 99406 | Low | Behav Chng Smoking 3-10 Min |
| 99407 | Low | Smoking And Tobacco Use Cessation Counseling Visit Intensive, Greather Than 10 Minutes Medicaid Level Of Care 6, As Defined By Each State |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99406. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99406 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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