| Category | Amount |
|---|---|
| Medicare Allowed Rate What Medicare approves for this service | $131.20 |
| Typical Billed Amount What providers commonly charge | $200 – $430 |
| Potential Markup How much more you might pay vs. Medicare rate | 228% above Medicare |
What CPT Code 99396 Means
CPT code 99396 represents a comprehensive annual physical exam for established patients between ages 40 and 64. This means you're seeing a doctor you've visited before (not a new patient visit) for your yearly checkup.
During this visit, your doctor will review your medical history, perform a physical examination, discuss preventive care like screenings and vaccinations, and address any health concerns. This is different from a sick visit – it's focused on keeping you healthy and catching potential problems early.
Your doctor uses this specific code because the exam is tailored to your age group, which has particular health screening needs like cholesterol checks, blood pressure monitoring, and cancer screenings that become more important in your 40s, 50s, and early 60s.
What to Expect on Your Bill
When you receive your bill or explanation of benefits, you'll see CPT code 99396 listed for your annual physical. The Medicare rate for this service is $131.20, but if you have private insurance or pay out-of-pocket, you'll typically see charges ranging from $200 to $430.
The good news is that most insurance plans, including Medicare, cover annual preventive exams at 100% with no copay or deductible when you see an in-network provider. However, if additional services are performed during your visit – like addressing a specific health concern or ordering extra tests – those may be billed separately and could result in additional costs.
You should see this code only once per year on your bills, as insurance typically covers just one comprehensive physical exam annually. If you see it billed more frequently, that could indicate a billing error.
How to Verify Your Billing is Correct
First, confirm that the date of service matches when you actually had your annual physical exam. Make sure you were between ages 40-64 at the time of the visit, as different age groups use different codes (like 99386 for the same exam when you're a new patient, or 99395 for ages 18-39).
Check that the charge falls within the typical range of $200-430. If it's significantly higher, contact your provider's billing department to ask for an explanation. Also verify that you're only being charged once per year for this service, unless you switched doctors mid-year.
If you notice any errors or have questions about your bill, don't hesitate to call your doctor's billing office. They can review your visit notes and explain exactly what services were provided. If you believe you've been incorrectly billed, ask for a detailed breakdown and request corrections if needed. Most billing departments are helpful in resolving these issues when you approach them politely and with specific questions.