| Category | Amount |
|---|---|
| Medicare Allowed Rate What Medicare approves for this service | $101.64 |
| Typical Billed Amount What providers commonly charge | $150 – $375 |
| Potential Markup How much more you might pay vs. Medicare rate | 269% above Medicare |
What CPT 99394 Means and When It's Used
CPT code 99394 represents a comprehensive preventive medicine visit for adolescents between 12 and 17 years old. This is the medical billing code your doctor's office uses when your teen has their annual well-check or physical exam.
During these visits, your teen's healthcare provider conducts a thorough evaluation including physical examination, health history review, immunization updates, and age-appropriate health counseling. The visit focuses on preventing health problems and ensuring your teenager is developing normally. Topics often covered include nutrition, exercise, mental health, substance abuse prevention, and sexual health education appropriate for their age.
This code is specifically for preventive care when your teen is healthy and not being treated for any specific illness or injury. If your teen has health concerns that require additional evaluation or treatment during the same visit, your provider may use additional codes alongside 99394.
How Billing Works for Teen Well-Check Visits
When you receive your medical bill or explanation of benefits, you'll see CPT code 99394 listed for your teen's preventive visit. The Medicare rate for this service is $101.64, though most patients don't use Medicare for teen visits. Private insurance companies negotiate their own rates with healthcare providers.
Typical charges for CPT 99394 range from $150 to $375, depending on your location and healthcare provider. The actual amount you pay depends on your insurance coverage. Many insurance plans cover preventive care visits at 100%, meaning you may owe nothing out-of-pocket. However, if you haven't met your deductible or have a copay for preventive services, you may be responsible for a portion of the cost.
Your bill should clearly show CPT 99394 with a description like 'preventive medicine visit' or 'well-check.' If you see additional codes on the same date, ask your provider's billing office to explain what additional services were provided and why they were necessary.
How to Verify Your Billing and Handle Billing Issues
To check if you were billed correctly, first confirm that your teen's visit was indeed a routine well-check and that they fall within the 12-17 age range for this code. If your teen was 11 or younger, the correct code should be 99393. If they were 18 or older, the code should be 99395 or 99396.
Compare the charge on your bill to the typical range of $150-$375. If the charge seems unusually high, contact your provider's billing office to request an itemized explanation. Sometimes additional services like vaccinations, lab work, or treatment for specific concerns are billed separately, which can increase the total cost.
If you believe there's an error, start by calling your healthcare provider's billing department. They can review the visit notes and explain the charges. If the issue isn't resolved, contact your insurance company to discuss the claim. Keep detailed records of all communications, including dates, names of representatives you spoke with, and reference numbers for your calls.