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See a sample rate comparisonCPT 99421 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.
Online Digital Evaluation And, Online Digital Evaluation And Management Service For An Established Patient For Up To 7 Days Cumulative Time During The 7 Days 5-10 Minutes
| Key Fact | Detail |
|---|---|
| Service Type | Evaluation and Management Preventive Medicine Services |
| Common Place of Service | 11 - Office 99 - Other POS |
| Common Modifiers | 95 - Telemedicine - audio and video GT - Via interactive audio and video telecommunication systems |
| Complexity Level | Low |
| Medicare Fee Schedule | $15.70 national non-facility rate (2026) · View Medicare rates for 99421 |
| Medicaid Fee Schedule | $12.555 median of the 8 states in the free preview · View Medicaid rates for 99421 |
National average reimbursement for CPT 99421 by major payers:
$19.85
$19.12
$17.39
$31.88
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CPT 99421
5 of 25 sample ratesHigher to lower in this preview
Luis Trujillo
Aurora Medical Group Inc
$52.72Published rateHisham Abdelmotilib
Methodist Hospital
$23.45Published rateAngeles Lai Zayas
Internal Medicine Of Pasadena PLLC
$19.37Published rateSalman Bandeali
Cardiology Associates PA
$12.42Published rateHarish Thakkar
Harish N. Thakkar, M.D., P.A.
$10.68Published rate
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See a sample payer proposalCPT 99421 vs. Other Preventive Medicine Services Codes
The CPT 99421 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 99421 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 |
|---|---|---|
| 99421-CPT | Low | Online Digital Evaluation And, Online Digital Evaluation And Management Service For An Established Patient For Up To 7 Days Cumulative Time During The 7 Days 5-10 Minutes |
| 99422-CPT | Low | Online Digital Evaluation And, Online Digital Evaluation And Management Service For An Established Patient For Up To 7 Days Cumulative Time During The 7 Days 11-20 Minutes |
| 99423-CPT | Low | Online Digital Evaluation And, Online Digital Evaluation And Management Service For An Established Patient For Up To 7 Days Cumulative Time During The 7 Days 21 Or More Minutes |
| 99424-CPT | Low | Prin Care Mgmt Phys 1st 30, Principal Care Management Services For A Single High Risk Disease With The Following Required Elements One Complex Chronic Condition Expected To Last At Least 3 Months And That Places The Patient At Significant Risk Of Hospitalization Acute Exacerbation Decompensation Functional Decline Or Death The Condition Requires Development Monitoring Or Revision Of Disease Specific Care Plan The Condition Requires Frequent Adjustments In The Medication Regimen And Or The Management Of The Condition Is Unusually Complex Due To Comorbidities Ongoing Communication And Care Coordination Between Relevant Practitioners Furnishing Care First 30 Minutes Provided Personally By A Physician Or Other Qualified Health Care Professional Per Calendar Month |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99421. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99421 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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