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CPT code 99394: Adolescent preventive visit, established, ages 12–172026 Medicare rate & RVUs

Established adolescent patients ages 12 through 17 receive a comprehensive preventive medicine visit with age-appropriate history, examination, screening, and counseling.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare rate · 99394

Adolescent preventive visit, established, ages 12–17

Office or facility?

Work RVUs
1.7
Total RVUs
2.18
Global days
XXX

National rate · 2026

—

Not priced in the facility setting.

See every locality for 99394 →Billed by an NP, PA or therapist? →

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What 99394 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 99394 covers

Code 99394 represents a routine preventive medicine reevaluation for an established patient age 12 through 17. Pediatricians, family physicians, and other qualified clinicians report it for adolescent wellness visits in office or outpatient settings. The encounter focuses on a broad health review and examination, preventive screening, and counseling or anticipatory guidance rather than evaluation of a single new complaint. Discussion may address development, safety, nutrition, activity, and risk reduction as relevant to the adolescent.

Medicare assigns physician fee schedule status N, meaning Medicare does not cover this service. Select the code for an established adolescent in the specified age range, not a new patient or a patient outside that range. If a distinct problem is also evaluated and managed, separate problem-oriented E/M reporting may be appropriate when the work and documentation meet applicable coding requirements; modifier 25 is commonly used for that separate service.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 99394 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

99394 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailableUnavailable
AlaskaUnavailableUnavailable
ArizonaUnavailableUnavailable
ArkansasUnavailableUnavailable
Atlanta, GAUnavailableUnavailable
Austin, TXUnavailableUnavailable
Bakersfield, CAUnavailableUnavailable
Baltimore area, MDUnavailableUnavailable
Beaumont, TXUnavailableUnavailable
Brazoria, TXUnavailableUnavailable

99394 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
99394 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 99394 rate is calculated

Each of 99394’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

How the rate is built · 99394

RVUs × geographic indexes × conversion factor

Office or facility?

Work1.70

1.70 RVUs× 1.000 GPCI

Practice expense1.76

1.76 RVUs× 1.000 GPCI

Malpractice0.11

0.11 RVUs× 1.000 GPCI

Adjusted RVUs

3.5700

Conversion factor

$33.4009

Medicare rate

$119.24

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 99394

99394 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.

Place of service · 99394

Which rate does Medicare pay?

The POS code on the claim line (CMS-1500 box 24B).

POS 11 · non-facility rate · national

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99394 isn’t priced in this setting.

99394 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 99394

    Adolescent preventive visit, established, ages 12–171.7 wRVU

    Not priced

  • 99384

    Adolescent preventive visit, new patient, ages 12–172 wRVU

    Not priced

  • 99393

    Child preventive visit, established patient, age 5-111.5 wRVU

    Not priced

  • 99395

    Preventive visit, established, age 18-391.75 wRVU

    Not priced

How to choose

99384Adolescent preventive visitNew patient, ages 12–17
Both codes cover preventive visits for ages 12 through 17. Choose 99384 for a new patient and 99394 for an established patient.
99393Child preventive visitEstablished patient, age 5-11
99393 is for established patients ages 5 through 11; 99394 is for established patients ages 12 through 17.
99395Preventive visitEstablished, age 18-39
99395 is for established patients ages 18 through 39; 99394 is for established adolescent patients ages 12 through 17.

Codes related to 99394

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to 99394
CodeHow it relatesNational office range
Same family
99393Child preventive visit, established patient, age 5-11Established-patient preventive visit for ages 5 through 11.No office rate
99395Preventive visit, established, age 18-39Established-patient preventive visit for ages 18 through 39.No office rate
99384Adolescent preventive visit, new patient, ages 12–17Preventive visit for a new patient ages 12 through 17.No office rate
99392Well-child visit, established, age 1–4Established-patient preventive visit for ages 1 through 4.No office rate

99394 billing questions

When should 99394 be selected instead of 99384?

Use 99394 for an established patient age 12 through 17. Code 99384 is for a new patient in that age range.

Which code applies when the established patient turns 18?

For an established patient ages 18 through 39, the corresponding preventive medicine code is 99395.

Can a problem-oriented E/M service be reported at the same visit?

It may be reported when a significant, separately identifiable problem is evaluated and managed beyond the preventive service. The documentation must support the distinct work, and modifier 25 is commonly used on the problem-oriented E/M code.

Does Medicare cover 99394?

No. Medicare physician fee schedule status N identifies this service as not covered by Medicare.

Does the patient's age alone determine whether 99394 applies?

No. Both the age range of 12 through 17 and established-patient status must fit. A new patient in that age range is reported with 99384.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates

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