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CPT 99397: Established Patient Well–Patient Visit, Age 65+
CPT code 99397 denotes a periodic comprehensive preventive medicine visit for an established patient aged 65 years or older. Nationally, this code captures annual well‑patient care for older adults and is central to preventive service delivery, chronic disease surveillance, and age‑appropriate screening. The code supports documentation of a comprehensive history, physical examination, counseling, and ordering of preventive diagnostics.
Key payers covered in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code's clinical scope and service setting, comparisons to adjacent preventive codes for other age groups, and the typical diagnostic contexts in which the code is used. The summary also identifies common payer engagement for this service and highlights the clinical relevance for primary care and geriatric providers.
This publication equips billing managers, clinicians, and policy staff with the operational context for CPT code 99397, including how it fits into preventive care workflows and which payers commonly reimburse the service. Data not available in the input are noted where applicable.
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Billing Code Overview
CPT code 99397 represents a periodic comprehensive preventive medicine reevaluation and management visit for an established patient aged 65 years or older. The service is a well–patient visit focused on preventive care, including age‑appropriate history, examination, counseling, anticipatory guidance, risk‑factor reduction, and ordering of appropriate screening or diagnostic services as needed.
Service type: Established patient preventive medicine visit (annual wellness/wellness exam).
Typical site of service: Outpatient office or clinic setting for primary care, geriatrics, or other ambulatory care practices.
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).