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 99409 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.
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
| Key Fact | Detail |
|---|---|
| Service Type | Evaluation and Management Preventive Medicine Services |
| Common Place of Service | 11 - Office 53 - Community Mental Health Center |
| Common Modifiers | 25 - Significant, separately identifiable E/M service same day 95 - Telemedicine - audio and video |
| Complexity Level | Low |
| ASAM Level | Level 0.5 - Early Intervention |
| Care Type | Screening |
| Setting | Outpatient |
| Medicare Fee Schedule | View Medicare rates for 99409 |
| Medicaid Fee Schedule | $56.745 median of the 8 states in the free preview · View Medicaid rates for 99409 |
National average reimbursement for CPT 99409 by major payers:
$82.21
$64.31
$69.87
$108.15
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 99409.
CPT 99409
5 of 25 sample ratesHigher to lower in this preview
Megan Tran
$216.86Published rateJennifer Charron
$166.55Published rateDon Allison
$99.00Published rateJohn Kremer
$85.13Published rateDaniel Cornish
$64.30Published 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 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 |
|---|---|---|
| 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 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.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 99409) and we'll show you how you compare in 15 minutes or less.