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CPT code 99396: Preventive visit, established, ages 40-642026 Medicare rate & RVUs

Reports a comprehensive preventive evaluation for an established patient ages 40 through 64, including age-appropriate history, examination, and preventive counseling.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare rate · 99396

Preventive visit, established, ages 40-64

Office or facility?

Work RVUs
1.9
Total RVUs
2.43
Global days
XXX

National rate · 2026

—

Not priced in the facility setting.

See every locality for 99396 →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 99396 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 99396 covers

This code is for a periodic comprehensive preventive medicine evaluation and management service for an established patient age 40 through 64. The clinician reviews age- and sex-appropriate health history, performs an appropriate preventive examination, and provides counseling or anticipatory guidance and risk-factor reduction as indicated. Family medicine and internal medicine practices commonly report this service during routine health-maintenance visits. Select the established-patient code based on patient status and age; a new patient in this age band falls under a different preventive medicine code.

Medicare does not cover this service. The code identifies the preventive evaluation itself; it is not a unit code for laboratory testing or other procedures. Its age band is 40 through 64, and established-patient status distinguishes it from 99386.

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 99396 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

99396 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

99396 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
99396 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 99396 rate is calculated

Each of 99396’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 · 99396

RVUs × geographic indexes × conversion factor

Office or facility?

Work1.90

1.90 RVUs× 1.000 GPCI

Practice expense1.84

1.84 RVUs× 1.000 GPCI

Malpractice0.12

0.12 RVUs× 1.000 GPCI

Adjusted RVUs

3.8600

Conversion factor

$33.4009

Medicare rate

$128.93

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

Payment rules and modifiers for 99396

99396 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 · 99396

Which rate does Medicare pay?

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

POS 11 · non-facility rate · national

—

99396 isn’t priced in this setting.

99396 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 99396

    Preventive visit, established, ages 40-641.9 wRVU

    Not priced

  • 99386

    Preventive visit, new patient, age 40–642.33 wRVU

    Not priced

  • 99395

    Preventive visit, established, age 18-391.75 wRVU

    Not priced

  • 99397

    Preventive exam, established patient, age 65+2 wRVU

    Not priced

How to choose

99386Preventive visitNew patient, age 40–64
Both are preventive visits for ages 40 through 64. Choose 99396 for an established patient and 99386 for a new patient.
99395Preventive visitEstablished, age 18-39
99395 is for an established patient ages 18 through 39; 99396 is for an established patient ages 40 through 64.
99397Preventive examEstablished patient, age 65+
99397 is for an established patient age 65 or older; 99396 applies through age 64.

Codes related to 99396

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

Codes related to 99396
CodeHow it relatesNational office range
Same family
99386Preventive visit, new patient, age 40–64Preventive evaluation for a new patient in the same 40-through-64 age range.No office rate
99395Preventive visit, established, age 18-39Established-patient preventive evaluation for ages 18 through 39.No office rate
99397Preventive exam, established patient, age 65+Established-patient preventive evaluation for ages 65 and older.No office rate
99394Adolescent preventive visit, established, ages 12–17Established-patient preventive evaluation for ages 12 through 17.No office rate

99396 billing questions

Which patients fit the age range for 99396?

Use it for an established patient who is age 40 through 64 at the preventive visit. The patient’s age and established-patient status distinguish it from neighboring preventive medicine codes.

How does 99396 differ from 99386?

Both codes describe preventive evaluations for patients ages 40 through 64. 99396 is for an established patient; 99386 is for a new patient.

When should 99395 or 99397 be used instead?

For an established patient, 99395 covers ages 18 through 39, while 99397 covers age 65 and older. 99396 is for ages 40 through 64.

Does Medicare cover 99396?

No. Medicare does not cover 99396.

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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