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See a sample rate comparisonCPT 99411 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.
Preventive Medicine Counseling, Preventive Medicine Counseling Andor Risk Factor Reduction Intervention(S) Provided To Individuals In A Group Setting (Separate Procedure) Approximately 30 Minutes
| Key Fact | Detail |
|---|---|
| Service Type | Evaluation and Management Preventive Medicine Services |
| Common Place of Service | 11 - Office 20 - Urgent Care Facility |
| Common Modifiers | 25 - Significant, separately identifiable E/M service same day 95 - Telemedicine - audio and video |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 99411 |
| Medicaid Fee Schedule | $16.25 median of the 8 states in the free preview · View Medicaid rates for 99411 |
National average reimbursement for CPT 99411 by major payers:
$20.95
$21.66
$22.43
$28.37
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CPT 99411
5 of 25 sample ratesHigher to lower in this preview
Talya Mandelkern
Beth Israel Deaconess Medical Center Inc
$65.01Published rateFaraz Kureshi
Mercy Clinic Springfield Communities
$24.45Published rateSusan Huynh
Dallas Hospitalist PA
$18.94Published rateBilly De Los Santos
Regional Employee Assistance Progra M
$16.79Published rateAnthony Oliva
Best Choice Primary Care PLLC
$6.34Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 99411 vs. Other Preventive Medicine Services Codes
The CPT 99411 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 99411 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-CPT | Low | Preventive Medicine Counseling, Preventive Medicine Counseling Andor Risk Factor Reduction Intervention(S) Provided To An Individual (Separate Procedure) Approximately 15 Minutes |
| 99402-CPT | Low | Preventive Medicine Counseling, Preventive Medicine Counseling Andor Risk Factor Reduction Intervention(S) Provided To An Individual (Separate Procedure) Approximately 30 Minutes |
| 99411-CPT | Low | Preventive Medicine Counseling, Preventive Medicine Counseling Andor Risk Factor Reduction Intervention(S) Provided To Individuals In A Group Setting (Separate Procedure) Approximately 30 Minutes |
| 99412-CPT | Low | Preventive Medicine Counseling, Preventive Medicine Counseling Andor Risk Factor Reduction Intervention(S) Provided To Individuals In A Group Setting (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 99411. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99411 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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