Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonCPT 99429 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.
Unlisted Preventive Medicine S, Unlisted Preventive Medicine Service
| Key Fact | Detail |
|---|---|
| Service Type | Evaluation and Management Preventive Medicine Services |
| Common Place of Service | 11 - Office 10 - Telehealth in Patient's Home 99 - Other POS |
| Common Modifiers | U5 |
| Complexity Level | Moderate |
| Medicare Fee Schedule | View Medicare rates for 99429 |
| Medicaid Fee Schedule | View Medicaid rates for 99429 |
National average reimbursement for CPT 99429 by major payers:
$495.84
$37.01
$45.00
$306.83
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 99429.
CPT 99429
5 of 25 sample ratesHigher to lower in this preview
Crosbyton Clinic Hospital
$1,272.00Published rateRestorative Health Rehabilitation Inc
$60.00Published rateRestorative Health Rehabilitation Inc
$55.00Published rateAll Ways Homecare Inc
$35.00Published rateBrian Dearing
Cardiology Associates Of Mobile, Inc.
$9.97Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 99429 vs. Other Preventive Medicine Services Codes
The CPT 99429 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 99429 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 |
|---|---|---|
| 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 |
| 99425-CPT | Low | Prin Care Mgmt Phys Ea Addl, 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 Each Additional 30 Minutes Provided Personally By A Physician Or Other Qualified Health Care Professional Per Calendar Month List Separately In Addition To Code For Primary Procedure |
| 99426-CPT | Low | Prin Care Mgmt Staff 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 Of Clinical Staff Time Directed By Physician Or Other Qualified Health Care Professional Per Calendar Month |
| 99429-CPT | Moderate | Unlisted Preventive Medicine S, Unlisted Preventive Medicine Service |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99429. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99429 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.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 99429) and we'll show you how you compare in 15 minutes or less.
Frequently Asked Questions
To understand the potential cost of a medical procedure or service, you can first contact your insurance provider to inquire about your coverage, deductible, co-payment, and co-insurance for the specific service. Additionally, for an estimate of the fee schedule, you can use tools like Payerprice. Payerprice offers a fee schedule lookup tool where you can search using a CPT code and your specific location to get an idea of the costs. This can help you anticipate your out-of-pocket expenses.
CPT stands for Current Procedural Terminology. CPT codes are standardized five-digit codes used by healthcare providers to describe the medical, surgical, and diagnostic services they provide to patients. They are crucial for understanding healthcare costs because insurance companies use these codes to process claims and determine reimbursement rates. Knowing the CPT code for a service allows you to research its typical cost, check your insurance coverage, and compare prices using tools like Payerprice.
This is a common scenario. The amount a provider bills is often their standard charge, which can be higher than what your insurance company actually pays or what you are ultimately responsible for. Insurance companies negotiate discounted rates with providers, known as contracted rates. Your insurance statement (Explanation of Benefits or EOB) will show the billed amount, the negotiated discount, the amount the insurance paid, and your remaining responsibility, which can include deductibles, co-payments, and co-insurance.
The best source for specific coverage information is your insurance provider. You can typically find a member services phone number on your insurance card or log into your online member portal. When you call, be ready to provide the specific CPT code for the service you're inquiring about, if you have it. They can explain your benefits, including whether the service is covered, your deductible status, co-pays, and co-insurance.
Comparing prices for healthcare services involves several steps. First, identify the specific service you need, ideally with its CPT code. Then, you can contact various providers in your area for their self-pay rates or estimates. For a more comprehensive approach, use a dedicated fee schedule lookup tool. Payerprice, for example, allows you to search for fee schedules by CPT code and specific location, providing valuable insights into typical costs and helping you make informed decisions.