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See a sample rate comparisonCPT 99417 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.
Prolng Off/Op E/M Ea 15 Min, Prolonged Office Or Other Outpatient Evaluation And Management Service(S) Beyond The Minimum Required Time Of The Primary Procedure Which Has Been Selected Using Total Time Requiring Total Time With Or Without Direct Patient Contact Beyond The Usual Service On The Date Of The Primary Service Each 15 Minutes Of Total Time (List Separately In Addition To Codes 99205 99215 For Office Or Other Outpatient Evaluation And Management Services)
| Key Fact | Detail |
|---|---|
| Service Type | Evaluation and Management Preventive Medicine Services |
| Common Place of Service | 11 - Office 22 - On Campus Outpatient Hospital |
| Common Modifiers | 95 - Telemedicine - audio and video 25 - Significant, separately identifiable E/M service same day |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 99417 |
| Medicaid Fee Schedule | $27.50 median of the 8 states in the free preview · View Medicaid rates for 99417 |
National average reimbursement for CPT 99417 by major payers:
$38.78
$38.78
$33.96
$56.02
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CPT 99417
5 of 25 sample ratesHigher to lower in this preview
Stephen Vorenberg
Beth Israel Deaconess Medical Center Inc
$108.38Published ratePediatric Associates Inc. Of Brockton
Pediatric Associates, Inc. Of Brockton
$88.26Published rateMichael Whitner
Atrius Health, Inc.
$78.45Published ratePedro Blandon
Pedro A Blandon Md PA
$36.75Published rateEdie Shulman
Scott & White Clinic
$26.50Published rate
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See a sample payer proposalCPT 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-CPT | 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-CPT | 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-CPT | Low | Prolng Off/Op E/M Ea 15 Min, Prolonged Office Or Other Outpatient Evaluation And Management Service(S) Beyond The Minimum Required Time Of The Primary Procedure Which Has Been Selected Using Total Time Requiring Total Time With Or Without Direct Patient Contact Beyond The Usual Service On The Date Of The Primary Service Each 15 Minutes Of Total Time (List Separately In Addition To Codes 99205 99215 For Office Or Other Outpatient Evaluation And Management Services) |
| 99418-CPT | Low | Prolng Ip/Obs E/M Ea 15 Min, 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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Frequently Asked Questions
CPT 99417 is a preventive medicine service code representing a moderate-complexity encounter. It stands apart from other preventive medicine service codes due to requiring more provider time and moderate medical decision-making. This often entails addressing multiple diagnoses, managing medications, or interpreting tests. In contrast, lower-level codes demand less time and simpler assessments. Consequently, CPT 99417 typically results in higher reimbursement and more extensive documentation requirements.
The factors that influence CPT 99417 fee schedules include Medicare & Medicaid Rates (government-determined reimbursement), Private Insurance Rates (negotiated between providers and insurers), Geographic Location (costs can be higher in urban areas), and Provider Type (e.g., hospital providers may have different rates than private practices). For specific fee schedule information based on your location and the CPT code, you can use Payerprice's fee schedule lookup tool.