CPT 99412 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 • None • 50 - Federally Qualified Health Center |
| Common Modifiers | • None • 95 - Telemedicine - audio and video • HD |
| Complexity Level | Moderate |
National average reimbursement for CPT 99412 by major payers:
$27.85
$28.14
$27.72
$37.17
| 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 99412 | ||||||
United | 99412 | $51.75 | 1578618161 - NAVEEN PEMMARAJU | 760273984 | TX | Internal Medicine Physician (207R00000X) |
United | 99412 | $21.78 | 1043420524 - MARIA TERESA RUBIO-PINAROC | 223875077 - (TX) TERESA R PINAROC MD PA | TX | Internal Medicine Physician (207R00000X) |
United | 99412 | $19.32 | 1053859322 - TEXAS INTEGRATIVE MEDICINE AND CARDIOLOGY, PLLC | 813986471 | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99412 | $46.45 | 1841377215 - YASIR KHAN | 824216940 - (TX) MILLENNIUM MEDICAL CARE PLLC | TX | Internal Medicine Physician (207R00000X) |
United | 99412 | $17.82 | 1316919228 - MANUEL MERCADO | 680501547 - (TX) MANUEL J MERCADO MD PA | TX | Internal Medicine Physician (207R00000X) |
United | 99412 | $27.84 | 1245230622 - RAJESH PATEL | 752368382 - (TX) RAJESH J PATEL MD PA | TX | Internal Medicine Physician (207R00000X) |
United | 99412 | $63.33 | 1740591874 - BETHANY AGUSALA | 756002868 | TX | Internal Medicine Physician (207R00000X) |
United | 99412 | $38.20 | 1962936153 - NICHOLAS VILLALTA | 831002191 - TEMPLE FACULTY PRACTICE PLAN INC | TX | Internal Medicine Physician (207R00000X) |
United | 99412 | $51.75 | 1437105541 - ELIE MOUHAYAR | 760273984 | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99412 | $23.05 | 1710141437 - JULIAN FALLA | 742959210 - (TX) GMG HEALTH SYSTEMS ASSOCIATES PA | TX | Internal Medicine Physician (207R00000X) |
United | 99412 | $20.50 | 1932106937 - JOHN BURPEAU | 760586813 - (TX) JOHN BURPEAU, M.D., P.A. | TX | Internal Medicine Physician (207R00000X) |
United | 99412 | $29.45 | 1538726195 - ZAHRA CAIN-AKBAR | 331298313 | TX | Neurology Physician (2084N0400X) |
United | 99412 | $31.04 | 1912994104 - JANETTE NGUYEN | 205287556 - (TX) PREMIER NW HOUSTON MEDICAL GROUP, PA | TX | Internal Medicine Physician (207R00000X) |
United | 99412 | $27.63 | 1457466369 - DAVID PANIAGUA | 264069086 | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99412 | $15.35 | 1205818853 - MARILYN MAYER | 760357448 - (TX) RONALD J TAYLOR MD PA | TX | Internal Medicine Physician (207R00000X) |
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 99412 vs. Other Preventive Medicine Services Codes
The CPT 99412 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 99412 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 |
| 99403 | Low | Preventive Medicine Counseling And/Or Risk Factor Reduction Intervention(S) Provided To An Individual (Separate Procedure); Approximately 45 Minutes |
| 99412 | Low | Preventive Medicine Counseling And/Or 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 99412. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99412 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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