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Current CMS pricing and breakdown for Prev visit est age 40-64.
This code is excluded/invalid for Medicare.
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A preventive medicine evaluation and management visit for an established patient between the ages of 40 and 64 years. Includes a comprehensive age-appropriate history, physical examination, counseling, anticipatory guidance, and ordering of appropriate laboratory or diagnostic procedures.
CPT code 99396 (A preventive medicine evaluation and management visit for an established patient between the ages of 40 and 64 years. Includes a comprehensive age-appropriate history, physical examination, counseling, anticipatory guidance, and ordering of appropriate laboratory or diagnostic procedures.) does not currently have a published national facility or non-facility reimbursement rate in 2026. The code carries 3.86 total RVUs across work, practice expense, and malpractice components.
99396 is a CPT code in the category “Physician Service.” Medicare does not publish a single national payment amount for this code in 2026 (Not Covered). This code is excluded/invalid for Medicare.
Because this code is not covered/invalid for Medicare, a reimbursement rate is not expected under Medicare rules. If you believe this should be payable, verify directly with CMS or your MAC.
| Component | Office (Non-Fac) | Facility (Hosp) |
|---|---|---|
| Work RVU | 1.9 | 1.9 |
| Practice Expense (PE) | 1.84 | 0.41 |
| Malpractice (MP) | 0.12 | 0.12 |
| Total RVUs | 3.86 | 2.43 |
Compare a payment against the Medicare benchmark for this code.
Medicare rates are used as a benchmark only. Actual payer contracts, modifiers, place of service, units, and billing rules may affect reimbursement. This tool is for educational and operational review purposes, not legal or billing advice.
Medicare often publishes two payment rates for the same code: a **non-facility** rate (typically used when the service is performed in a private office where the clinician bears more overhead) and a **facility** rate (typically used when performed in a hospital or facility where the facility bills separately for its costs).
Because the practice expense portion of RVUs differs by setting, the non-facility and facility payment amounts can be different. For locality-adjusted estimates in 2026, use MedFeeSchedule's Medicare Physician Fee Schedule Lookup Tool.
Medicare reimbursement is determined by RVUs, geographic adjustments, and the annual conversion factor.
Medicare does not cover/recognize 99396 as payable under its rules (This code is excluded/invalid for Medicare.). A national reimbursement rate is not expected for 2026.
A preventive medicine evaluation and management visit for an established patient between the ages of 40 and 64 years. Includes a comprehensive age-appropriate history, physical examination, counseling, anticipatory guidance, and ordering of appropriate laboratory or diagnostic procedures.
For many physician services, Medicare publishes different practice-expense RVUs by setting. In general, non-facility rates apply when services are performed in a private office, while facility rates apply when performed in a hospital or facility where the facility bills separately.
Use MedFeeSchedule's Medicare Physician Fee Schedule Lookup Tool on the homepage to estimate your locality-adjusted reimbursement. Medicare payment can vary based on geographic adjustments (GPCI), place of service, and claim specifics.
Coverage depends on medical necessity, setting, and Medicare policy. Some codes may be bundled, contractor-priced, or restricted. Verify final coverage guidance through CMS or your local MAC when applicable.