CPT 99397
Global XXXPer pm reeval est pat 65+ yr
CPT 99397 Billing & Documentation Guide
CPT code 99397 (Per pm reeval est pat 65+ yr) is classified under E/M with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 2, a non-facility practice expense RVU of 2.04, and a malpractice RVU of 0.12, a total non-facility RVU of 4.16 and facility RVU of 2.55. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $142.71, though rates vary from $127.4 to $174.98 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 99397, 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 99397 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 99397 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 99397
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 2 | 2 |
| Practice Expense RVU | 2.04 | 0.43 |
| Malpractice RVU | 0.12 | 0.12 |
| Total RVU | 4.16 | 2.55 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 99397
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 | $151.99 | $88.36 | $144.76 - $174.55 | 29 |
| Florida | $142.97 | $89.02 | $137.97 - $147.87 | 3 |
| Georgia | $136.7 | $85.4 | $132.36 - $141.04 | 2 |
| Illinois | $140.54 | $88.57 | $135.28 - $144.95 | 4 |
| Michigan | $136.43 | $85.93 | $133.54 - $139.31 | 2 |
| North Carolina | $132.94 | $82.76 | $132.94 - $132.94 | 1 |
| New York | $151.43 | $91.44 | $134.35 - $159.54 | 5 |
| Ohio | $133.05 | $83.95 | $133.05 - $133.05 | 1 |
| Pennsylvania | $138.43 | $85.76 | $133.14 - $143.72 | 2 |
| Texas | $137.98 | $85.03 | $132.53 - $142.58 | 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 99397
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 99397 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 99397
What does CPT code 99397 mean? +
CPT code 99397 represents: Per pm reeval est pat 65+ yr. It's in the E/M category with a global period of XXX.
What is the Medicare reimbursement for CPT 99397? +
The 2026 Medicare national average non-facility payment for CPT 99397 is $142.71. Rates range from $127.4 to $174.98 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 99397? +
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 99397? +
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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