CPT 99417 Fee Schedule
Last Updated: April 2025
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)
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 - Synchronous telemedicine service via real-time audio and video telecommunications • 25 - Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service |
| Complexity Level | Moderate |
National average reimbursement for CPT 99417 by major payers:
$38.78
$38.61
$33.96
$58.77
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.
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.
| CPT Code | Complexity Level | 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) |
See what providers are getting paid in 2024 for 99417:
CPT 99417 Fee Schedule & Reimbursement Rates
The CPT 99417 fee schedule varies by payer type. Below are Medicare rates for 2024 and average in-network rates by state across major payers:
| Code | Medicare Rate | Avg. Cigna National Rate | More Info |
|---|---|---|---|
| 99415 | $20.64 | $32.56 | |
| 99416 | $9.65 | $20.65 | |
| 99417 | $30.63 | $58.77 | |
| 99418 | $38.95 | $72.73 | |
| 99437 | $59.59 | ||
| 99439 | $47.93 | $76.92 |
Reimbursement rates depend on provider contracts, region, and payer. Always verify rates with your insurance provider or medical billing department.
What is price transparency?
The Price Transparency Rule is a federal law that took effect in July 2022, requiring all commercial payers to publicly disclose their prices through machine-readable files (MRFs). In short, this regulation mandates that insurance companies make healthcare costs transparent to the public.
Our data comes directly from these insurer-posted MRFs, ensuring compliance with the Price Transparency Rule. While PayerPrice is working toward a future where providers and payers collaborate for 100% upfront price certainty, it's important to acknowledge that data limitations and occasional errors may exist.
Healthcare Price Transparency Rule
cms.govConsumer Guide To Healthcare Prices
aha.orgGlossary of Healthcare Terms
healthcare.govUnlock access to price transparency insights today.
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