Code Reality Check
99395 reimbursement rate: Preventive visit, established pt, age 18-39
Preventive visit, established pt, age 18-39 (CPT 99395) pays a median $220.14 in New Hampshire and $94.17 in Kentucky, against a Medicare anchor of $124.85. 51 of 51 states clear the publication floor.
spread 2.3x top to bottom
Medicare anchor $124.85
51/51 states published
The 50-state spread
as of 2026-07-15| State | Median | vs Medicare | Band | Rate points | Tier |
|---|---|---|---|---|---|
| New Hampshire | $220.14 | 1.76x | $160–$228 · P90 $288 | 8,478 | Benchmark |
| Wisconsin | $174.63 | 1.40x | $116–$267 · P90 $300 | 43,679 | Benchmark |
| Massachusetts | $160.10 | 1.28x | $118–$220 · P90 $265 | 7,463 | Benchmark |
| Colorado | $151.97 | 1.22x | $115–$228 · P90 $228 | 8,832 | Benchmark |
| District of Columbia | $145.43 | 1.16x | $112–$151 · P90 $220 | 2,563 | Benchmark |
| Minnesota | $142.53 | 1.14x | $112–$198 · P90 $223 | 8,086 | Benchmark |
| Vermont | $131.39 | 1.05x | $110–$220 · P90 $224 | 1,256 | Benchmark |
| Maine | $131.11 | 1.05x | $99–$188 · P90 $222 | 9,923 | Benchmark |
| Virginia | $128.34 | 1.03x | $112–$158 · P90 $200 | 27,819 | Benchmark |
| Maryland | $125.27 | 1.00x | $112–$151 · P90 $205 | 5,470 | Benchmark |
| Connecticut | $125.27 | 1.00x | $113–$191 · P90 $278 | 3,805 | Benchmark |
| Delaware | $125.27 | 1.00x | $107–$151 · P90 $217 | 691 | Benchmark |
| New York | $125.27 | 1.00x | $121–$192 · P90 $291 | 169,729 | Benchmark |
| New Jersey | $124.83 | 1.00x | $98–$158 · P90 $224 | 18,985 | Benchmark |
| Hawaii | $124.79 | 1.00x | $99–$167 · P90 $239 | 855 | Benchmark |
| North Dakota | $123.93 | 0.99x | $100–$167 · P90 $223 | 336 | Benchmark |
| Rhode Island | $123.02 | 0.99x | $100–$138 · P90 $220 | 4,758 | Benchmark |
| Nebraska | $122.49 | 0.98x | $94–$171 · P90 $231 | 587 | Benchmark |
| Iowa | $122.43 | 0.98x | $100–$159 · P90 $232 | 1,517 | Benchmark |
| South Dakota | $121.35 | 0.97x | $97–$167 · P90 $227 | 263 | Benchmark |
| Louisiana | $120.65 | 0.97x | $97–$167 · P90 $268 | 1,437 | Benchmark |
| Utah | $119.01 | 0.95x | $91–$167 · P90 $281 | 1,054 | Benchmark |
| Oregon | $118.95 | 0.95x | $91–$171 · P90 $318 | 1,888 | Benchmark |
| Washington | $118.68 | 0.95x | $88–$167 · P90 $301 | 3,421 | Benchmark |
| South Carolina | $118.59 | 0.95x | $91–$167 · P90 $175 | 6,784 | Benchmark |
| Florida | $117.86 | 0.94x | $93–$148 · P90 $221 | 16,336 | Benchmark |
| Pennsylvania | $117.57 | 0.94x | $101–$133 · P90 $185 | 17,764 | Benchmark |
| Montana | $117.10 | 0.94x | $93–$167 · P90 $267 | 502 | Benchmark |
| California | $116.80 | 0.94x | $78–$264 · P90 $451 | 148,391 | Benchmark |
| Illinois | $116.76 | 0.94x | $99–$140 · P90 $254 | 13,985 | Benchmark |
| Michigan | $116.76 | 0.94x | $97–$153 · P90 $230 | 6,355 | Benchmark |
| Indiana | $116.76 | 0.94x | $105–$123 · P90 $151 | 53,992 | Benchmark |
| Arizona | $116.76 | 0.94x | $91–$159 · P90 $253 | 3,648 | Benchmark |
| New Mexico | $116.76 | 0.94x | $91–$167 · P90 $267 | 1,044 | Benchmark |
| Oklahoma | $116.67 | 0.93x | $91–$151 · P90 $223 | 1,194 | Benchmark |
| Nevada | $115.82 | 0.93x | $86–$167 · P90 $280 | 1,672 | Benchmark |
| Idaho | $115.74 | 0.93x | $91–$163 · P90 $223 | 647 | Benchmark |
| Wyoming | $115.70 | 0.93x | $78–$132 · P90 $165 | 752 | Benchmark |
| Mississippi | $113.23 | 0.91x | $91–$167 · P90 $241 | 732 | Benchmark |
| Arkansas | $112.35 | 0.90x | $91–$158 · P90 $220 | 1,219 | Benchmark |
| Tennessee | $111.29 | 0.89x | $87–$138 · P90 $191 | 7,032 | Benchmark |
| Alaska | $109.13 | 0.87x | $86–$161 · P90 $234 | 373 | Benchmark |
| Alabama | $108.87 | 0.87x | $86–$133 · P90 $208 | 2,710 | Benchmark |
| Georgia | $108.85 | 0.87x | $86–$170 · P90 $278 | 102,517 | Benchmark |
| Kansas | $106.46 | 0.85x | $90–$125 · P90 $176 | 1,699 | Benchmark |
| Missouri | $106.11 | 0.85x | $88–$124 · P90 $166 | 52,656 | Benchmark |
| Texas | $104.83 | 0.84x | $52–$133 · P90 $191 | 38,635 | Benchmark |
| North Carolina | $101.09 | 0.81x | $91–$167 · P90 $167 | 97,181 | Benchmark |
| Ohio | $97.10 | 0.78x | $74–$147 · P90 $186 | 92,822 | Benchmark |
| West Virginia | $97.10 | 0.78x | $83–$121 · P90 $168 | 1,921 | Benchmark |
| Kentucky | $94.17 | 0.75x | $71–$115 · P90 $153 | 22,296 | Benchmark |
Payer-blind local peer percentiles per state, full verified distribution. Publication floor: 11 verified rate points and a non-degenerate spread; the P25–P75 band unlocks at 25 points, P90 at 100 (a smaller cell's P90 is one contract, not a statistic).
Documented reimbursement figures are modeled, not guaranteed. Derived from federally mandated Transparency in Coverage data (45 CFR 147.212). No PHI.
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Cite this page
Source: Reddenda Code Reality Check, CPT 99395. Reddenda. https://reddenda.health/code/99395/
Derivation federally mandated TiC MRFs, verified to provider identity1,027,754 verified rate points across 51 statesas of 2026-07-15 · methodology v1.0