CPT 99409 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 • 53 - Community Mental Health Center |
| Common Modifiers | • None • 25 - Significant, separately identifiable E/M service same day • 95 - Telemedicine - audio and video |
| Complexity Level | Moderate |
National average reimbursement for CPT 99409 by major payers:
$82.21
$64.31
$69.87
$112.77
| 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 99409 | ||||||
United | 99409 | $81.18 | 1871501742 - WHITE RIVER FAMILY HEALTH CLINIC | 202829866 | WA | Family Medicine Physician (207Q00000X) |
United | 99409 | $191.52 | 1538622907 - KATE SLAYMAKER | 911512896 | WA | Family Medicine Physician (207Q00000X) |
United | 99409 | $81.18 | 1922266162 - STACEY HILES | 262967434 | WA | Family Medicine Physician (207Q00000X) |
United | 99409 | $81.18 | 1194739987 - TANYA BRYANT | 141928467 | WA | Family Medicine Physician (207Q00000X) |
United | 99409 | $87.86 | 1467547760 - SCOTT FANNIN | 260236458 | WA | Family Medicine Physician (207Q00000X) |
United | 99409 | $70.70 | 1861804577 - JESSE KLEBBA | 383081615 | WA | Family Medicine Physician (207Q00000X) |
United | 99409 | $166.55 | 1538622907 - KATE SLAYMAKER | 911512896 | WA | Family Medicine Physician (207Q00000X) |
United | 99409 | $97.01 | 1215518113 - HARKNESS MEDICAL GROUP, PLLC | 862989713 | WA | Family Medicine Physician (207Q00000X) |
United | 99409 | $90.50 | 1194739987 - TANYA BRYANT | 141928467 | WA | Family Medicine Physician (207Q00000X) |
United | 99409 | $87.30 | 1952925570 - PAMELA ANGELO | 273920921 | WA | Family Medicine Physician (207Q00000X) |
United | 99409 | $93.05 | 1104277375 - ELISABETH GEHRINGER | 912168190 | WA | Family Medicine Physician (207Q00000X) |
United | 99409 | $171.78 | 1932198892 - BRETT DANIEL | 910369070 | WA | Family Medicine Physician (207Q00000X) |
United | 99409 | $149.50 | 1760831051 - ALISON CLARKE | 331065485 | WA | Family Medicine Physician (207Q00000X) |
United | 99409 | $164.35 | 1518372416 - JOHN RAYMOND STOREY | 910214500 | WA | Family Medicine Physician (207Q00000X) |
United | 99409 | $82.12 | 1932359551 - SUKHDIP DHILLON | 911020139 | WA | Family Medicine Physician (207Q00000X) |
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 99409 vs. Other Preventive Medicine Services Codes
The CPT 99409 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 99409 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 |
| 99409 | Low | Alcohol And/Or Substance (Other Than Tobacco) Abuse Structured Screening (Eg 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 99409. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99409 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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