CPT 99417 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 • 22 - On Campus Outpatient Hospital • None |
| Common Modifiers | • None • 95 - Telemedicine - audio and video • 25 - Significant, separately identifiable E/M service same day |
| Complexity Level | Moderate |
National average reimbursement for CPT 99417 by major payers:
$38.78
$38.78
$33.96
$58.77
| 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 99417 | ||||||
United | 99417 | $88.26 | 1306834650 - MICHAEL LYONS | 43414523 - (MA) MEDICAL ASSOCIATES PEDIATRICS, P.C. | MA | Pediatrics Physician (208000000X) |
United | 99417 | $88.26 | 1275582611 - NURIA GINE-NOKES | 43439351 - (MA) LEXINGTON PEDIATRICS, PC | MA | Pediatrics Physician (208000000X) |
United | 99417 | $99.37 | 1447464466 - NICOLE RANDAZZO-AHERN | 42312909 - MASS GENERAL BRIGHAM INCORPORATED | MA | Pediatrics Physician (208000000X) |
United | 99417 | $74.22 | 1174986020 - DAVID HORVAT | 530196580 - CHILDRENS HOSPITAL | TX | Neurology Physician (2084N0400X) |
United | 99417 | $88.26 | 1134141757 - ERICA KATES | 42479693 - (MA) HOLYOKE PEDIATRIC ASSOCIATES, LLP | MA | Pediatrics Physician (208000000X) |
United | 99417 | $75.70 | 1386131399 - ANKITA ANITA DEOSTHALI | 231352166 - THE CHILDRENS HOSPITAL OF PHILADELPHIA | MA | Pediatrics Physician (208000000X) |
United | 99417 | $88.26 | 1932305240 - SHANA ZANDMAN | 464697588 - (MA) SHANA ZANDMANMD PC | MA | Pediatrics Physician (208000000X) |
United | 99417 | $72.36 | 1851370688 - ALINE HUTNER | 237425849 - (MA) EAST BOSTON NEIGHBORHOOD HEALTH CENTER CORP | MA | Pediatrics Physician (208000000X) |
United | 99417 | $59.50 | 1023002888 - CHARLES JONES | 752600873 - (TX) SHANNON CLINIC | TX | Internal Medicine Physician (207R00000X) |
United | 99417 | $82.11 | 1922140037 - LAURA LAMBERT | 43148394 - (MA) TUFTS MEDICAL CENTER PHYSICIANS ORGANIZATION INC | MA | Pediatrics Physician (208000000X) |
United | 99417 | $57.77 | 1710073937 - RODNEY LIGHT | 742958277 - SCOTT & WHITE CLINIC | TX | Internal Medicine Physician (207R00000X) |
United | 99417 | $26.85 | 1528170081 - NEILL WHITE | 863038792 - (TX) SOUTHWEST TEXAS TWO MEDICAL GROUP PLLC | TX | Internal Medicine Physician (207R00000X) |
United | 99417 | $52.90 | 1952600637 - MINESH DESAI | 300520570 - (TX) METHODIST HOSPITAL | TX | Internal Medicine Physician (207R00000X) |
United | 99417 | $77.12 | 1841289030 - FERNANDO ARZOLA | 550483245 - PRINCETON COMMUNITY HOSPITAL ASSN INC | TX | Internal Medicine Physician (207R00000X) |
United | 99417 | $33.95 | 1649366261 - SAJID MALIK | 760507363 | TX | Neurology Physician (2084N0400X) |
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 99417 vs. Other Preventive Medicine Services Codes
The CPT 99417 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 99417 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 |
|---|---|---|
| 99415 | Low | Prolonged Clinical Staff Service (The Service Beyond The Highest Time In The Range Of Total Timeof The Service) During An Evaluation And Management Service In The Office Or Outpatient Setting Direct Patient Contact With Physician Supervision; First Hour (List Separately In Addition To Code For Outpatient Evaluation And Management Service) (Desc Rvsd 1/1/21) |
| 99416 | Low | Prolonged Clinical Staff Service (The Service Beyond The Highest Time In The Range Of Total Timeof The Service) During An Evaluation And Management Service In The Office Or Outpatient Setting Direct Patient Contact With Physician Supervision; Each Additional 30 Minutes (List Separately In Addition To Code For Prolonged Service) (Desc Rvsd 1/1/21) |
| 99417 | Low | Prolonged Outpatient Evaluation And Management Service(S) Time With Or Without Direct Patient Contact Beyond The Required Time Of The Primary Service When The Primary Service Level Has Been Selected Using Total Time Each 15 Minutes Of Total Time (List Separately In Addition To The Code Of The Outpatient Evaluation And Management Service) (Desc Rvsd 1/1/23) For Office Or Other Outpatient Evaluation And Management Services) |
| 99418 | Low | Prolonged Inpatient Or Observation Evaluation And Management Service(S) Time With Or Without Direct Patient Contact Beyond The Required Time Of The Primary Service When The Primary Service Level Has Been Selected Using Total Time, Each 15 Minutes Of Total Time (List Separately In Addition To The Code Of The Inpatient And Observation Evaluation And Management Service) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99417. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99417 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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