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

CMS doesn’t publish an office rate for 99396 in New York.

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

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 in New York

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

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.

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.

99396 compared with similar codes

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.

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