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CPT 99397

Excluded from PFS

99397 · PFS Q4 2025 · Historical

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

View applicable payment rules
View CMS source and method

Not at a published national rate. CPT 99397 carries status N (non-covered) in the Q4 2025 release. Medicare covers no part of this service. Treat the blank amount as unpriced, not as $0.

PFS status evidence

Physician relative value file (Q4 2025) · rvu25d-updated-09-11-2025.zip (PPRRVU2025_Oct.csv row 12,879)
Inspect PFS status evidence
Code
99397
Release
Q4 2025, revision 1
Result
Excluded from PFS

Citations

  • Establishes the PFS status (N) and the resulting pathway for this code: excluded from pfs.

    Physician relative value file (PPRRVU)

    Q4 2025 · revision 1

    Latest revision of this release

    Release period: October 1 – December 31, 2025

    This PFS record alone does not establish a $0 allowance or a coverage determination. Any amount from another schedule needs its own evidence.

    Record details PPRRVU2025_Oct.csv in rvu25d-updated-09-11-2025.zip (row 12,879)
    hcpcs (col 1)
    99397
    modifier (col 2)
    blank
    status_code (col 4)
    N

    SHA-256: 8af460f38bf982b79b07269fbc8b7256a8ef3bd3aa025a9c5cb71c1e52523c56

    Original source file

Compact facts

Why is there no national PFS amount for 99397?

Its status indicator is N (non-covered). Medicare covers no part of this service. Status N: non-covered. Medicare covers no part of this service, so the PFS produces no payment amount.

About this code

Also known as Annual physical

Payment considerations Copy link

The inputs and payment rules that apply to this code. Each link jumps to its detail below.

Other payment indicators (10)

Facility/non-facility: Not determined, Professional/technical component: Does not apply, Bilateral adjustment: Does not apply, Multiple-procedure reduction: Does not apply, Assistant/co-surgeon treatment: Does not apply, Global surgery: Does not apply, NCCI same-day edits: Not determined, MUE behavior: Not determined, Other fee-schedule routing: Does not apply, Contractor pricing: Does not apply.

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. $160.76
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. $160.44
G0439 Every annual wellness visit after the first. This is the code most established Medicare patients need each year. $126.47

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 Q4 2025 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.

Payment rules

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

XXX Does not apply

The global surgery concept does not apply to this code.

Can you bill it with another code? Copy link

Enter a second CPT or HCPCS code billed on the same date of service. We'll check the current NCCI procedure-to-procedure edit between it and 99397.

See every current NCCI pair for 99397 →

Common payment questions Copy link

Why would a Medicare claim for 99397 be denied or paid less?

These come from CMS indicators 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.

History

Rate history by release Copy link

National office (non-facility) amount for 99397 across quarterly releases.

Release Status Office Facility
Q4 2026 takes effect Oct 1, 2026 N — —
Q3 2026 Jul 1, 2026 – Sep 30, 2026 N — —
Q2 2026 Apr 1, 2026 – Jun 30, 2026 N — —
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.

Usage & related

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Source & method

Show sources

This page uses CMS's Medicare Physician Fee Schedule Q4 2025 release (effective October 2025). National baselines use GPCI 1.000 and exclude sequestration. Status and payment instructions determine whether a national amount is established; blank RVUs stay blank. Releases are immutable: historical evidence remains tied to the specified release. Our methodology explains sourcing, parsing, versioning, and how we cross-check claims before they ship.

Physician relative value file (Q4 2025) · rvu25d-updated-09-11-2025.zip (PPRRVU2025_Oct.csv row 12,879)

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

Cite this rate

This citation identifies the source release, so its evidence remains reproducible after a newer release lands.

CPT 99397 National PFS baseline: No national PFS rate (Q4 2025; participating; whole service; GPCI 1.000; sequestration excluded). Localis. https://localishealth.com/cpt/99397/2025/D