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

Preventive Exam, Established Patient, Age 65+

CPT 99397

Also known as Annual physical

Reported for a patient's annual well-visit exam at this age, separate from any problem-focused visit.

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 99397 in Q1 2023? Copy link

Not at a published national rate. CPT 99397 carries status N (non-covered) in the Q1 2023 release. Medicare covers no part of this service. Treat the blank amount as unpriced, not as $0.

Source: Physician relative value file (Q1 2023) · effective January 2023 · materially updated Aug 4, 2026 · compact facts

What Medicare pays for instead of 99397 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. $166.73
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. $166.39
G0439 Every annual wellness visit after the first. This is the code most established Medicare patients need each year. $130.13

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 99397 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 Q1 2023 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 99397.

See every current NCCI pair for 99397 →

Global period: what 99397's fee already covers Copy link

XXX Does not apply

The global surgery concept does not apply to this code.

Modifiers that report work outside 99397's global period
Modifier Reports
-25 A significant, separately identifiable E/M on the same day as the procedure, beyond its usual pre- and post-operative care.

A modifier reports what happened; it does not by itself make a service payable. Documentation has to support it.

Common questions Copy link

Why is there no payment amount for 99397?

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 99397 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 99397 mean?

CPT code 99397: Preventive Exam, Established Patient, Age 65+. Reported for a patient's annual well-visit exam at this age, separate from any problem-focused visit.

Computation & policy
History & related

Rate history by release Copy link

National non-facility amount for 99397 across quarterly releases.

Release Status Non-facility Facility
Q3 2026 Jul 1, 2026 – present N — —
Q2 2026 Apr 1, 2026 – Jun 30, 2026 N — —
Q1 2026 Jan 1, 2026 – Mar 31, 2026 N — —

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Source & method

Show sources

This is computed from CMS's Medicare Physician Fee Schedule Q1 2023 release (schedule pfs, effective January 2023). 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.

Description written from primary sources: CMS Medicare Physician Fee Schedule Relative Value Files. Not derived from AMA CPT descriptor text.

Physician relative value file (Q1 2023) · rvu23a-updated-01-31-2023.zip (PPRRVU23_JAN.csv row 17,926)

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 Q1 2023 figures, even after a newer release lands.

CPT 99397 Medicare Physician Fee Schedule rate (Q1 2023). Localis. https://localishealth.com/cpt/99397/2023/A