CPT 99397: Established Patient Well Visit, Age 65 and Older
Commercial payers pay $152 on average nationally for this procedure.
CPT code 99397 describes a periodic comprehensive preventive medicine visit for an established patient aged 65 years or older, encompassing an age-appropriate history, physical examination, counseling, anticipatory guidance, and planning for preventive services; the service type is a preventive/wellness visit and the typical site of service is an outpatient office or clinic visit for primary care or geriatrics.
For related coverage guidance, see recent payer policy updates: DRG Newborn Inpatient Stays - Facility, Pediatric Preventive Screening, Pediatric Preventive Screening.
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National Reimbursement Benchmarks
National commercial reimbursements for CPT 99397 cluster around BUCA’s average commercial rate of $151.70, with notable variation by payer. UnitedHealth Group posts the highest central tendency at a median of $167.60 and a mean of $186.00, while Cigna and Aetna sit below that with medians of $147.80 and $132.40 respectively; Blue Cross Blue Shield’s median is $122.90. BUCA’s mean at $151.70 serves as a mid-market reference among these payers. Dispersion (P75 minus P25) highlights differences in consistency: Blue Cross Blue Shield is the tightest with a spread of $52.20 ($156.60−$104.40), while Aetna and UnitedHealth Group show wider spreads of $111.40 ($210.30−$92.90) and $105.90 ($231.60−$125.70) respectively, indicating more variability in allowed amounts. Cigna’s spread is $98.80 ($207.00−$108.20) and BUCA’s is $79.90 ($186.50−$106.60).