CPT code 99397: Preventive exam, established patient, age 65+2026 Medicare rate & RVUs

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

What 99397 covers

Code 99397 represents a periodic preventive medicine evaluation for an established patient age 65 or older. A physician or other qualified clinician typically performs it in an office or outpatient setting. The visit centers on preventive health rather than evaluation of a new or worsening complaint, and may include review of health history, an age-appropriate examination, and counseling about risk reduction and health maintenance. Selection is based on the patient's age and established-patient status, not on the particular preventive concern addressed.

Medicare identifies 99397 as not covered, with physician fee schedule status N. Medicare annual wellness visits are distinct services: G0438 is the initial annual wellness visit, and G0439 is a subsequent annual wellness visit. Those codes are not interchangeable with this comprehensive preventive medicine service. For an established patient age 65 or older, 99397 is the age-specific preventive medicine code; the corresponding new-patient service is 99387.

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 99397 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

99397 rates by state

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

How the 99397 rate is calculated

Each of 99397’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 99397

99397 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.

99397 compared with similar codes

How to choose

99387Preventive visitNew patient, age 65+

Both are preventive medicine services for patients age 65 or older. Use 99387 for a new patient and 99397 for an established patient.

99396Preventive visitEstablished, ages 40-64

Both apply to established patients, but 99396 is for ages 40 through 64; 99397 is for age 65 or older.

G0438Annual wellness visitInitial visit, first AWV

G0438 describes an initial Medicare annual wellness visit, not the comprehensive preventive medicine reevaluation represented by 99397.

G0439Annual wellness visitSubsequent visit

G0439 describes a subsequent Medicare annual wellness visit. It is distinct from the comprehensive preventive examination coded with 99397.

Codes related to 99397

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