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 99407 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.
Smoking And Tobacco Use Cessation Counseling Visit Intensive, Greather Than 10 Minutes Medicaid Level Of Care 6, As Defined By Each State
| Key Fact | Detail |
|---|---|
| Service Type | Evaluation and Management Preventive Medicine Services |
| Common Place of Service | 11 - Office 21 - Inpatient Hospital |
| Common Modifiers | 25 - Significant, separately identifiable E/M service same day 95 - Telemedicine - audio and video |
| Complexity Level | Low |
| Medicare Fee Schedule | $29.06 national non-facility rate (2026) · View Medicare rates for 99407 |
| Medicaid Fee Schedule | $23.48 median of the 8 states in the free preview · View Medicaid rates for 99407 |
National average reimbursement for CPT 99407 by major payers:
$32.57
$33.89
$33.95
$49.49
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 99407.
CPT 99407
5 of 25 sample ratesHigher to lower in this preview
Carmine Grieco
Osu Radiology LLC
$99.97Published rateTanya Baldwin
$44.59Published rateAma Nuamah
University Hospitals Health System Inc
$33.52Published rateWilliam Hablitzel
Adams County Auditor
$25.47Published rateHopewell Health Centers Inc, Family Healthcare Inc
Hopewell Health Centers Inc
$21.45Published 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 99407 vs. Other Preventive Medicine Services Codes
The CPT 99407 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 99407 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 |
|---|---|---|
| 99406-CPT | Low | Smoking And Tobacco Use Cessat, Smoking And Tobacco Use Cessation Counseling Visit Intermediate Greater Than 3 Minutes Up To 10 Minutes |
| 99407-CPT | Low | Smoking And Tobacco Use Cessation Counseling Visit Intensive, Greather Than 10 Minutes Medicaid Level Of Care 6, As Defined By Each State |
| 99408-CPT | Low | Alcohol Andor Substance (Othe, Alcohol Andor Substance (Other Than Tobacco) Abuse Structured Screening (E.G. Audit Dast) And Brief Intervention (Sbi) Services 15 To 30 Minutes |
| 99409-CPT | Low | Alcohol Andor Substance (Othe, Alcohol Andor Substance (Other Than Tobacco) Abuse Structured Screening (E.G. Audit Dast) And Brief Intervention (Sbi) Services Greater Than 30 Minutes |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99407. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99407 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 99407) and we'll show you how you compare in 15 minutes or less.
Frequently Asked Questions
To find the estimated cost of a medical procedure before you have it, you should first contact your healthcare provider's billing department for their charges or an estimate. Next, reach out to your insurance company to understand your specific benefits, including your deductible, co-pays, and co-insurance, as these significantly affect your out-of-pocket costs. For a general idea of costs based on specific CPT codes and your location, you can utilize Payerprice's fee schedule lookup tool.
CPT stands for Current Procedural Terminology. These are a standardized set of medical codes used by healthcare providers to describe the medical, surgical, and diagnostic services they perform. CPT codes are crucial for understanding costs because they allow for consistent identification of services across different providers, enabling standardized billing, accurate insurance claim processing, and effective price comparison. Knowing the CPT code for a specific service will help you obtain more accurate pricing information, for example, when using a tool like Payerprice.
Your insurance plan profoundly impacts the price you pay for medical services. It dictates your deductible (the amount you must pay out-of-pocket before your insurance begins to cover costs), your co-pay (a fixed fee you pay for a specific service), and your co-insurance (a percentage of the cost you are responsible for after meeting your deductible). Furthermore, your insurance company negotiates discounted rates with providers, meaning the 'allowed amount' for a service is typically lower than the provider's initial billed charge. Always contact your insurance provider to fully understand your specific coverage and potential out-of-pocket expenses.
To look up healthcare prices for specific services in your area, you can start by asking your healthcare provider for a direct estimate or their cash price for the service. Your insurance company can also provide estimated costs based on their negotiated rates with in-network providers. For a comprehensive tool that allows you to search for fee schedules using CPT codes and specific locations to get an idea of estimated prices and compare costs for various services in your area, you should refer to Payerprice.
A 'billed charge' is the initial, often highest, amount that a healthcare provider charges for a medical service or procedure. This is the provider's sticker price. A 'negotiated rate' (also known as an 'allowed amount' or 'contracted rate') is the discounted price that an insurance company has agreed to pay a provider for a particular service as part of their contract. When you have insurance, your out-of-pocket costs (deductibles, co-pays, co-insurance) are typically calculated based on this negotiated rate, not the higher billed charge. Price transparency tools, such as Payerprice, often provide estimated prices based on these negotiated rates.