CPT 99396
Global XXXPrev visit est age 40-64
CPT 99396 Billing & Documentation Guide
CPT code 99396 (Prev visit est age 40-64) is classified under E/M with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 1.9, a non-facility practice expense RVU of 1.84, and a malpractice RVU of 0.12, a total non-facility RVU of 3.86 and facility RVU of 2.43. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $132.33, though rates vary from $118.32 to $162.85 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 99396, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 99396 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Non-covered service
No global period (E/M and other non-procedural services)
MUE Limit (Medically Unlikely Edits)
Submitting more than 0 units of 99396 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 99396
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.9 | 1.9 |
| Practice Expense RVU | 1.84 | 0.41 |
| Malpractice RVU | 0.12 | 0.12 |
| Total RVU | 3.86 | 2.43 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 99396
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $140.63 | $84.11 | $134.05 - $161.21 | 29 |
| Florida | $132.93 | $85 | $128.24 - $137.58 | 3 |
| Georgia | $126.99 | $81.41 | $123.06 - $130.91 | 2 |
| Illinois | $130.73 | $84.58 | $125.84 - $134.87 | 4 |
| Michigan | $126.82 | $81.96 | $124.1 - $129.53 | 2 |
| North Carolina | $123.36 | $78.8 | $123.36 - $123.36 | 1 |
| New York | $140.48 | $87.2 | $124.66 - $148.04 | 5 |
| Ohio | $123.61 | $80 | $123.61 - $123.61 | 1 |
| Pennsylvania | $128.52 | $81.73 | $123.67 - $133.36 | 2 |
| Texas | $128.04 | $81.02 | $123.11 - $132.16 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 99396
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 99396 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0359T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0360T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0361T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0362T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0363T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0364T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0365T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0366T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0367T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0368T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 99396
What does CPT code 99396 mean? +
CPT code 99396 represents: Prev visit est age 40-64. It's in the E/M category with a global period of XXX.
What is the Medicare reimbursement for CPT 99396? +
The 2026 Medicare national average non-facility payment for CPT 99396 is $132.33. Rates range from $118.32 to $162.85 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 99396? +
E/M codes commonly use modifier 25 (significant separately identifiable E/M on same day as a procedure), 57 (decision for major surgery), 24 (unrelated E/M during global period), 95 (synchronous audio+video telehealth), 93 (audio-only telehealth), and AI (principal physician of record on admission). Surgical modifiers like 50, 51, 59 do not apply to E/M.
What bundling edits apply to CPT 99396? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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