Preventive Medicine
CPT Code 99397
Preventive medicine visit, established patient, age 65+
National Average Rate
$170.00
CMS non-facility rate
Facility Rate
$129.00
Hospital / outpatient facility
Data Source
CMS Medicare
Physician Fee Schedule 2024
What This Means for Your Bill
- Medicare pays $170.00 nationally for CPT 99397 in a non-facility (office) setting.
- In a hospital or outpatient facility the rate drops to $129.00 because the facility bills separately.
- Private insurers typically pay 110–140% of the Medicare rate, so a fair price is roughly $213–$238.
- If your bill shows a charge significantly above this, you may have grounds to negotiate or dispute it.
How to Use This Information
1
Find CPT 99397 on your itemized bill — hospitals are required to provide one on request.
2
Compare the charged amount to $170.00 — if your bill is 2× or more, that's a red flag.
3
Use our AI bill analyzer to scan your full bill, flag errors, and get a dispute letter in under 2 minutes.
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