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Describe a service in plain words, or type a CPT/HCPCS code.

CPT 99395

No national payment amount

Status N: non-covered. Medicare covers no part of this service, so the PFS produces no payment amount.

Did Medicare pay separately for CPT 99395 in Q3 2020? Copy link

Not at a published national rate. CPT 99395 carries status N (non-covered) in the Q3 2020 release. Medicare covers no part of this service. Treat the blank amount as unpriced, not as $0.

Source: Physician relative value file (Q3 2020) · effective July 2020 · materially updated Aug 4, 2026 · compact facts

What Medicare pays for instead of 99395 Copy link

Medicare covers its own preventive visits instead, under three G codes that the fee schedule does price. Which one applies depends entirely on how long the patient has had Part B and whether they have used the initial visit before.

Code When it applies Medicare amount
G0402 The Welcome to Medicare visit. This is the only one of the three billable during the patient's first 12 months of Part B coverage, and it is available once per lifetime. $168.54
G0438 The first annual wellness visit, billable once the patient has had Part B for more than 12 months. Once per beneficiary per lifetime — a claim from a previous practice uses it up, so check eligibility before billing it for a new patient. $172.87
G0439 Every annual wellness visit after the first. This is the code most established Medicare patients need each year. $117.29

Routine physical checkups are excluded from Medicare coverage by statute, which is why every preventive medicine visit code carries status N. CMS states the point directly: a preventive medicine service billed with these codes is a noncovered service, and providers are instructed not to bill annual wellness visits with them.

Being non-covered is not the same as being bundled: there is no Medicare payment for 99395 to fold into another service. What that means for billing the patient depends on why the code is not covered — services excluded by statute are treated differently from services ruled out by a coverage determination — and the status letter alone does not record which applies. How status indicators work covers the distinction.

Amounts computed from the Q3 2020 Physician Fee Schedule release, national (GPCI 1.000), office (non-facility) setting, before the ~2% sequestration cut. Each code above was checked against that release before being shown here.

Can you bill it with another code? Copy link

Enter a second CPT or HCPCS code billed the same date of service to check the current NCCI procedure-to-procedure edit between it and 99395.

See every current NCCI pair for 99395 →

Common questions Copy link

Why is there no payment amount for 99395?

Its status indicator is N (non-covered). Medicare covers no part of this service. The blank is deliberate: the amount is either unknown or paid under another provision, so reading it as $0 would be wrong.

Why would a Medicare claim for 99395 be denied or paid less?

Each item below comes from a CMS indicator on this page — not general billing advice.

  • Its status indicator is N (non-covered) — Medicare covers no part of this service. See status indicators

Payer-specific coverage and documentation rules live outside these files, so a claim that clears every check here can still be denied on other grounds.

When does this rate change?

CMS publishes a fee schedule release every quarter (January, April, July, October), and each is versioned here. 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? Copy link

For patients
What does CPT code 99395 mean?

We haven't written the plain-language description for CPT 99395 yet — ask your provider's billing office what service it covers in the meantime.

Computation & policy

How this amount is computed Copy link

amount = (work RVU × work GPCI + PE RVU × PE GPCI + MP RVU × MP GPCI) × conversion factor. National amounts use GPCI = 1.000. To price an RVU figure of your own, use the RVU-to-dollars converter.

Release Q3 2020
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 blank means CMS publishes no national number for that part. Read it as unknown, and never as zero.

History & related

Rate history by release Copy link

National non-facility amount for 99395 across quarterly releases.

Release Status Non-facility Facility
Q3 2026 Jun 30, 2026 – present N — —
Q2 2026 Mar 10, 2026 – Jun 29, 2026 N — —
Q1 2026 Dec 29, 2025 – Mar 9, 2026 N — —

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Source & method

Show sources

This is computed from CMS's Medicare Physician Fee Schedule Q3 2020 release (schedule pfs, effective July 2020). National amounts apply a GPCI of 1.000 and leave sequestration off. The status indicator decides payability, never the RVU values, so a blank RVU stays blank. Releases are immutable: a rate retrieved for a past quarter always reflects that release. Commercial and cash-pay figures anywhere on this page are arithmetic on the Medicare amount, using commonly cited reimbursement ranges. They're illustrative, and no nationwide claims database stands behind them. Our methodology covers all of this in depth — sourcing, parsing, versioning, and how claims are cross-checked before they ship.

Physician relative value file (Q3 2020) · rvu20c-updated-06192020.zip (PPRRVU20_V0618.csv row 17,242)

Conversion factor $36.0896 read from the same file, row 11, column 25.

Use the (i) buttons next to each amount above for the exact row, columns, and math.

Cite this rate

This link keeps pointing at the Q3 2020 figures, even after a newer release lands.

CPT 99395 Medicare Physician Fee Schedule rate (Q3 2020). Localis. https://localishealth.com/cpt/99395/2020/C