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See a sample rate comparisonCPT 99422 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 11-20 Minutes
| Key Fact | Detail |
|---|---|
| Service Type | Evaluation and Management Preventive Medicine Services |
| Common Place of Service | 11 - Office 10 - Telehealth in Patient's Home |
| Common Modifiers | 95 - Telemedicine - audio and video GT - Via interactive audio and video telecommunication systems |
| Complexity Level | Low |
| Medicare Fee Schedule | $30.73 national non-facility rate (2026) · View Medicare rates for 99422 |
| Medicaid Fee Schedule | $24.835 median of the 8 states in the free preview · View Medicaid rates for 99422 |
National average reimbursement for CPT 99422 by major payers:
$38.19
$38.19
$34.54
$56.08
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CPT 99422
5 of 25 sample ratesHigher to lower in this preview
Trung Nguyen
$90.72Published rateRohan Mehta
Scott & White Clinic
$51.22Published rateSalvador Murra
Privia Medical Group - Gulf Coast
$38.27Published rateGabriela Pichardo Lafontaine
Resilient Health
$26.34Published rateAnisha Waxali Md PA
Anisha Waxali, M.D., P.A.
$23.21Published rate
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See a sample payer proposalCPT 99422 vs. Other Preventive Medicine Services Codes
The CPT 99422 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 99422 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 99422. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99422 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
Determining the exact cost of a medical procedure beforehand can be complex due to varying factors like your insurance plan, provider's negotiated rates, and geographical location. To get an estimate, especially for specific CPT codes and your location, we recommend using a specialized tool. Payerprice offers a fee schedule lookup tool where you can search with a CPT code and specific location to find relevant pricing information and help you understand potential costs.
CPT (Current Procedural Terminology) codes are a standardized set of five-digit codes used by medical professionals to describe medical, surgical, and diagnostic services. They are crucial for billing and reimbursement, as they communicate what services were provided. Each CPT code has an associated fee, which varies significantly based on factors like the provider, geographic location, and whether you're insured. Tools like Payerprice's fee schedule lookup can help you find typical costs associated with specific CPT codes in your area.
It's common for medical bills to be confusing, and verifying fairness can be challenging. To compare the charges on your bill against standard rates for your specific location and CPT codes, you can utilize pricing transparency tools. We recommend using Payerprice's fee schedule lookup tool. By inputting the CPT codes from your bill and your location, you can search for prevailing rates and understand if your charges align with typical pricing. It's also advisable to contact your insurance provider and the billing department of the medical facility for clarification.
Fee schedules for medical services, which list the maximum reimbursement amounts for procedures, vary widely. While some general information might be available, specific and localized data is more useful. For a precise and practical way to find fee schedules tailored to CPT codes and your specific location, we recommend using Payerprice. Their specialized fee schedule lookup tool allows you to input specific CPT codes and your geographical area to retrieve relevant pricing data.
Yes, comparing prices for healthcare services is increasingly possible and highly recommended for informed decision-making. Tools are emerging to help consumers with this. To compare prices for specific services (identified by CPT codes) across different providers or facilities in your desired location, we suggest utilizing Payerprice. Their fee schedule lookup tool is designed to provide pricing information based on CPT codes and location, helping you to compare potential costs and make more cost-effective choices.