Preventive Exam, Established Patient, Age 40-64
CPT 99396
Status N Non-covered service. Not paid by Medicare. Full definition →No national payment amount
Status N is not separately payable under the PFS.
Non-covered service. Not paid by Medicare.
Common questions
Why is there no payment amount for 99396?
Its status indicator is N (non-covered). Non-covered service. Not paid by Medicare. The blank is deliberate: the amount is unknown or paid another way, not zero.
When does this rate change?
CMS publishes a fee schedule release every quarter (January, April, July, October). Each release is versioned here, so past quarters stay lookupable — see what changed each release, or get an email when a new release moves rates.
Sources: CMS Medicare Physician Fee Schedule Relative Value Files.
Saw this code on your bill?
What is a 99396 visit in patient-friendly terms?
In plain terms: An annual well-visit preventive exam for an established patient age 40 through 64, including an age-appropriate history, exam, and risk-factor counseling separate from a problem-focused office visit. You'll typically see CPT 99396 on a bill or explanation of benefits (EOB) when a clinician performs or bills for this service.
How this amount is computed
amount = (work RVU × work GPCI + PE RVU × PE GPCI + MP RVU × MP GPCI) × conversion factor. National amounts use GPCI = 1.000.
| Component | RVU |
|---|---|
| Work RVU | blank |
| Practice expense RVU (non-facility) | blank |
| Practice expense RVU (facility) | blank |
| Malpractice RVU | blank |
Every rate combines three parts: work (the clinician’s time, skill and effort), practice expense (office overhead — higher when the service is done in a doctor’s own office), and malpractice (the share of liability-insurance cost). A value of blank means CMS publishes no national number for that part — which is not the same as zero.
Rate history by release
National non-facility amount for 99396 across quarterly releases. Up 6.6% since Q1 2025 · high $128.93 in Q1 2026
| Release | Status | Non-facility | Facility |
|---|---|---|---|
| Q3 2026 Jun 30, 2026 | N | $128.93 (0.0%) | $81.16 (0.0%) |
| Q2 2026 Mar 10, 2026 | N | $128.93 (0.0%) | $81.16 (0.0%) |
| Q1 2026 Dec 29, 2025 | N | $128.93 (+6.6%) | $81.16 (-9.7%) |
| Q4 2025 Sep 11, 2025 | N | $120.98 (0.0%) | $89.92 (0.0%) |
| Q3 2025 Jun 5, 2025 | N | $120.98 (0.0%) | $89.92 (0.0%) |
| Q2 2025 Jun 5, 2025 | N | $120.98 (0.0%) | $89.92 (0.0%) |
| Q1 2025 Dec 23, 2024 | N | $120.98 | $89.92 |