CPT 99394: Established Adolescent Well‑Patient Visit, Ages 12–17
Commercial payers pay $116 on average nationally for this procedure.
CPT code 99394 describes an established patient periodic preventive medicine examination for adolescents aged 12–17, a well‑patient visit focusing on age‑appropriate preventive care, anticipatory guidance, screening, and routine counseling; the service type is a periodic preventive medicine evaluation and the typical site of service is an outpatient clinic or office visit for pediatric or family medicine care.
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National Reimbursement Benchmarks
National commercial rates for CPT 99394 cluster around BUCA’s average commercial rate of $115.70, with notable variation among major carriers. UnitedHealth Group posts the highest central tendency (median $141.60) and also shows a substantial upper skew, while Cigna and Aetna sit near BUCA’s level but with higher upper tails. Blue Cross Blue Shield’s median is lower, reflecting a generally tighter midrange compared with some peers.
Measuring dispersion as P75 minus P25, UnitedHealth Group is the widest with a spread of $90.00 ($196.10 - $106.00), followed by Cigna at $59.70 ($175.40 - $91.40). Blue Cross Blue Shield is the tightest among listed payers with a spread of $39.80 ($110.60 - $69.80); BUCA’s interquartile range is $64.50 ($142.40 - $79.90), indicating moderate variability around its average commercial rate.