2025 CPT code 99386
(Active) Effective Date: N/A Revision Date: N/A Preventive Medicine - New Patient Evaluation and Management > Preventive Medicine Services Feed
Initial comprehensive preventive medicine evaluation and management for a new patient aged 40-64 years, including history, exam, counseling, and ordering of labs/diagnostic procedures.
Modifier 25 may be appended if a significant, separately identifiable E/M service was performed on the same day. Modifier 33 (Preventive Services) can also be used but is not always required.
Medical necessity for CPT code 99386 is established by the patient's age (40-64 years), their status as a new patient, and the need for a comprehensive preventive medicine evaluation. The service should be medically appropriate and necessary based on the patient's risk factors and overall health status.
The clinical responsibility for code 99386 rests with the physician or qualified healthcare professional performing the comprehensive preventive medicine evaluation and management service. This includes obtaining a detailed history, performing a thorough physical examination, providing age and gender-appropriate counseling, and ordering necessary diagnostic tests.
- Evaluation and Management > Preventive Medicine Services
- Evaluation and Management > Preventive Medicine Services > New Patient
In simple words: This code is for a new patient's first checkup, between ages 40 and 64.The doctor reviews your medical history, does a physical exam, talks about preventing future health problems, and might order tests.
CPT code 99386 represents an initial, comprehensive preventive medicine evaluation and management service for new patients aged 40-64 years.This includes a detailed age- and gender-appropriate history, a comprehensive examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of appropriate laboratory/diagnostic procedures.This code is used when a provider conducts a thorough assessment of a patient's health status, risk factors, and potential healthcare needs during a preventive care visit.It does not include immunization administration or vaccine/toxoid products, which are reported separately.
Example 1: A 55-year-old woman, new to the practice, comes in for her first annual physical. The physician performs a comprehensive history and physical, orders blood work (lipid panel, CBC, etc.), and discusses preventative measures for heart disease, osteoporosis, and colon cancer, based on her age and risk factors., A 48-year-old male, new to the practice, presents for a preventive exam. The physician conducts a comprehensive assessment that includes a family history review, lifestyle counseling, and ordering of routine blood tests, which reveals slightly elevated cholesterol.The physician provides counseling on lifestyle modifications and starts the patient on a statin medication, requiring separate E/M codes with modifier 25. , A 60-year-old female, new to the practice, presents for a comprehensive physical. The physician completes the preventive visit, including counseling on age-appropriate cancer screening, and orders a mammogram, bone density scan, and colonoscopy, all billed separately.
Thorough documentation is crucial and should include: a detailed history (including family history, social history, and review of systems); a complete physical examination; documentation of counseling and anticipatory guidance provided; a record of any diagnostic testing ordered; and the results of any diagnostic testing performed.
** This code is only for new patients.It is crucial to confirm payer-specific requirements and coding guidelines before billing.
- Revenue Code: M1A (Office Visits - New)
- RVU: Refer to the CMS Physician Fee Schedule for the most up-to-date RVU values and reimbursement rates.These values vary based on geographic location and other factors.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Fee Schedule: Historical fee schedule data can be obtained from publicly available sources such as the CMS Physician Fee Schedule database.These values are subject to change and should be confirmed before billing.
- Specialties:Family Medicine, Internal Medicine, Geriatric Medicine
- Place of Service:Office