Code Reality Check
99396 reimbursement rate: Preventive visit, established pt, age 40-64
Preventive visit, established pt, age 40-64 (CPT 99396) pays a median $283.02 in North Dakota and $99.77 in Nevada, against a Medicare anchor of $131.61. 51 of 51 states clear the publication floor.
spread 2.8x top to bottom
Medicare anchor $131.61
51/51 states published
The 50-state spread
as of 2026-07-15| State | Median | vs Medicare | Band | Rate points | Tier |
|---|---|---|---|---|---|
| North Dakota | $283.02 | 2.15x | $127–$335 · P90 $353 | 3,680 | Benchmark |
| Oregon | $263.95 | 2.01x | $177–$311 · P90 $366 | 12,973 | Benchmark |
| Nebraska | $259.66 | 1.97x | $133–$296 · P90 $297 | 5,633 | Benchmark |
| Wisconsin | $258.63 | 1.97x | $150–$365 · P90 $527 | 51,877 | Benchmark |
| South Dakota | $251.10 | 1.91x | $122–$331 · P90 $345 | 3,599 | Benchmark |
| Montana | $198.96 | 1.51x | $177–$297 · P90 $332 | 2,550 | Benchmark |
| Massachusetts | $188.20 | 1.43x | $133–$260 · P90 $292 | 35,584 | Benchmark |
| New Hampshire | $173.86 | 1.32x | $142–$240 · P90 $328 | 9,944 | Benchmark |
| Vermont | $173.05 | 1.31x | $124–$230 · P90 $253 | 1,566 | Benchmark |
| Wyoming | $167.83 | 1.28x | $120–$233 · P90 $295 | 1,322 | Benchmark |
| Washington | $165.07 | 1.25x | $145–$272 · P90 $330 | 24,286 | Benchmark |
| Idaho | $164.99 | 1.25x | $120–$200 · P90 $274 | 1,520 | Benchmark |
| Colorado | $163.75 | 1.24x | $124–$247 · P90 $345 | 19,818 | Benchmark |
| Pennsylvania | $161.87 | 1.23x | $113–$237 · P90 $277 | 54,160 | Benchmark |
| Connecticut | $152.77 | 1.16x | $142–$253 · P90 $421 | 12,973 | Benchmark |
| California | $150.15 | 1.14x | $113–$419 · P90 $546 | 197,294 | Benchmark |
| West Virginia | $146.49 | 1.11x | $117–$184 · P90 $281 | 7,740 | Benchmark |
| Utah | $145.64 | 1.11x | $108–$203 · P90 $233 | 7,394 | Benchmark |
| Illinois | $144.06 | 1.09x | $113–$193 · P90 $261 | 41,195 | Benchmark |
| South Carolina | $141.64 | 1.08x | $122–$205 · P90 $257 | 17,138 | Benchmark |
| Iowa | $139.40 | 1.06x | $126–$335 · P90 $390 | 8,874 | Benchmark |
| New Mexico | $137.58 | 1.05x | $107–$171 · P90 $234 | 4,063 | Benchmark |
| Mississippi | $136.34 | 1.04x | $111–$136 · P90 $177 | 5,495 | Benchmark |
| District of Columbia | $133.73 | 1.02x | $123–$227 · P90 $320 | 3,642 | Benchmark |
| New York | $133.39 | 1.01x | $123–$202 · P90 $344 | 236,750 | Benchmark |
| Maine | $132.96 | 1.01x | $103–$190 · P90 $236 | 12,480 | Benchmark |
| Louisiana | $131.99 | 1.00x | $125–$166 · P90 $254 | 8,786 | Benchmark |
| Tennessee | $131.59 | 1.00x | $109–$247 · P90 $307 | 20,432 | Benchmark |
| Rhode Island | $131.51 | 1.00x | $108–$164 · P90 $252 | 7,364 | Benchmark |
| Indiana | $131.20 | 1.00x | $112–$147 · P90 $176 | 68,467 | Benchmark |
| Hawaii | $130.19 | 0.99x | $116–$182 · P90 $271 | 1,159 | Benchmark |
| Michigan | $129.92 | 0.99x | $128–$166 · P90 $215 | 28,375 | Benchmark |
| North Carolina | $129.28 | 0.98x | $91–$182 · P90 $259 | 125,615 | Benchmark |
| Alaska | $127.81 | 0.97x | $96–$182 · P90 $264 | 568 | Benchmark |
| New Jersey | $126.71 | 0.96x | $107–$185 · P90 $273 | 33,955 | Benchmark |
| Maryland | $125.74 | 0.96x | $117–$232 · P90 $278 | 17,459 | Benchmark |
| Minnesota | $125.03 | 0.95x | $125–$228 · P90 $321 | 22,578 | Benchmark |
| Kansas | $123.98 | 0.94x | $110–$129 · P90 $178 | 6,122 | Benchmark |
| Virginia | $123.26 | 0.94x | $113–$167 · P90 $214 | 41,681 | Benchmark |
| Arkansas | $122.04 | 0.93x | $122–$161 · P90 $189 | 6,161 | Benchmark |
| Florida | $120.46 | 0.92x | $99–$170 · P90 $249 | 45,281 | Benchmark |
| Georgia | $119.55 | 0.91x | $100–$186 · P90 $280 | 123,797 | Benchmark |
| Missouri | $118.83 | 0.90x | $96–$172 · P90 $208 | 64,171 | Benchmark |
| Delaware | $110.79 | 0.84x | $111–$135 · P90 $233 | 1,936 | Benchmark |
| Kentucky | $110.41 | 0.84x | $86–$155 · P90 $194 | 28,329 | Benchmark |
| Texas | $108.68 | 0.83x | $93–$148 · P90 $229 | 70,941 | Benchmark |
| Alabama | $108.58 | 0.83x | $109–$129 · P90 $174 | 9,006 | Benchmark |
| Ohio | $108.05 | 0.82x | $92–$168 · P90 $243 | 106,700 | Benchmark |
| Oklahoma | $103.05 | 0.78x | $80–$154 · P90 $201 | 5,630 | Benchmark |
| Arizona | $100.78 | 0.77x | $92–$164 · P90 $281 | 12,847 | Benchmark |
| Nevada | $99.77 | 0.76x | $99–$158 · P90 $262 | 5,127 | 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 99396. Reddenda. https://reddenda.health/code/99396/
Derivation federally mandated TiC MRFs, verified to provider identity1,646,037 verified rate points across 51 statesas of 2026-07-15 · methodology v1.0