CPT 99439 Fee Schedule
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 • Care Management Services |
| Common Place of Service | • 11 - Office • None • 99 - Other POS |
| Common Modifiers | • None • GV - Attending physician is not employed or paid under agreement by the patient's Hospice provider • GW - Condition not related to the patient's terminal condition |
| Complexity Level | Low |
National average reimbursement for CPT 99439 by major payers:
$52.51
$49.52
$47.48
$76.92
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 99439 | ||||||
United | 99439 | $90.95 | 1053844928 - JOHN SOOY | 43397450 - (MA) ATRIUS HEALTH, INC. | MA | Pediatrics Physician (208000000X) |
United | 99439 | $40.38 | 1730647108 - NANCY NAGDA | 43159969 - (MA) MILFORD REGIONAL PHYSICIAN GROUP INC | MA | Pediatrics Physician (208000000X) |
United | 99439 | $27.02 | 1396907366 - ROBERT POSTLEWAIT | 742935944 - (TX) SOUTH AUSTIN FAMILY PRACTICE CLINIC, PLLC | TX | Internal Medicine Physician (207R00000X) |
United | 99439 | $29.70 | 1083195648 - FF CORPORATION PLLC, BENTLEY HEART | 824623890 - (TX) FF CORPORATION PLLC | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99439 | $23.37 | 1629155700 - CLARA OSUJI | 262723985 | TX | Internal Medicine Physician (207R00000X) |
United | 99439 | $30.69 | 1932111614 - JONG YOO | 873259293 - (TX) CARROLLTON FIRST CARE MEDICAL CENTER PLLC | TX | Internal Medicine Physician (207R00000X) |
United | 99439 | $29.78 | 1851133904 - TEXAS INNOVATIVE MEDICS PLLC | 922328009 - (TX) TEXAS INNOVATIVE MEDICS PLLC | TX | Internal Medicine Physician (207R00000X) |
United | 99439 | $44.11 | 1740228063 - PAUL AGGARWAL | 823992578 - (TX) TEXAS HEART CENTER PLLC | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99439 | $78.47 | 1013265776 - ABBAS ZAIDI | 463160718 - NEMOURS NEW JERSEY PHYSICIAN PRACTICE PC | MA | Pediatrics Physician (208000000X) |
United | 99439 | $32.95 | 1982682225 - VICTORIANO VALDEZ | 742525045 - (TX) THE KICKAPOO TRADITIONAL TRIBE OF TEXAS | TX | Internal Medicine Physician (207R00000X) |
United | 99439 | $39.15 | 1386661965 - MOHAMMED HAQUE | 721281395 | TX | Internal Medicine Physician (207R00000X) |
United | 99439 | $102.33 | 1700888419 - ELIZABETH LENTINI | 42676414 - (MA) ANDOVER PEDIATRICS, P.C. | MA | Pediatrics Physician (208000000X) |
United | 99439 | $76.01 | 1063409001 - ROBERT ANDERSON | 752613493 - TEXAS HEALTH PHYSICIANS GROUP | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99439 | $35.72 | 1518039965 - YASSIR SONBOL | 462009634 - (TX) COMPLETE CARDIOLOGY CARE | TX | Cardiovascular Disease Physician (207RC0000X) |
United | 99439 | $21.92 | 1982840393 - PEDRO ABANTO | 845003224 - (TX) WOUND CARE INSTITUTE OF TEXAS PLLC | TX | Internal Medicine Physician (207R00000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 99439 vs. Other Care Management Services Codes
The CPT 99439 code is part of the Evaluation and Management services used for Care Management 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 99439 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 | 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) |
| 99439-CPT | Low | Chronic Care Management Services With The Following Required Elements: Multiple (Two Or More) Chronic Conditions Expected To Last At Least12 Months Or Until The Death Of The Patient Chronic Conditions That Place The Patient At Significant Risk Of Death Acute Exacerbation/ Decompensation Or Functional Decline Comprehen- Sive Care Plan Established Implemented Revised Or Monitored; Each Additional 20 Minutes Of Cinical Staff Time Directed By (Desc Rvsd 1/1/22) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99439. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99439 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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