CPT code 99394: Adolescent preventive visit, established, ages 12–172026 Medicare rate & RVUs in Florida
Established adolescent patients ages 12 through 17 receive a comprehensive preventive medicine visit with age-appropriate history, examination, screening, and counseling.
CMS doesn’t publish an office rate for 99394 in Florida.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
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 in Florida
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Fort Lauderdale, FL | Unavailable | Unavailable |
| Miami, FL | Unavailable | Unavailable |
| Rest of Florida | Unavailable | Unavailable |
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
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
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.
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
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