2025 CPT code 99385
(Active) Effective Date: N/A Revision Date: N/A Preventive Medicine - Preventive Medicine Services Evaluation and Management Feed
Initial comprehensive preventive medicine evaluation and management for a new patient aged 18-39 years, including history, exam, counseling, and ordering of lab/diagnostic procedures.
Modifier 25 may be added if a significant, separately identifiable E/M service is performed on the same day. Modifier 33 (Preventive Services) may be used in certain circumstances but is generally not required.
Medical necessity is established by the need for a comprehensive preventative medicine evaluation and management service for a new patient aged 18-39 years.This would include the assessment of overall health status and risk factors appropriate for the patient's age and gender. This is usually covered by insurance.
The physician or qualified healthcare professional performs a comprehensive history and physical examination, assesses risk factors, provides counseling and anticipatory guidance, and orders appropriate diagnostic tests and immunizations (billed separately).
- Evaluation and Management
- Evaluation and Management > Preventive Medicine Services > New Patient
In simple words: This code covers a complete check-up for a new adult patient between the ages of 18 and 39.The doctor will review your medical history, perform a physical exam, discuss ways to prevent health problems, and may order tests.Any shots or extra tests will be billed separately.
This CPT code reports a comprehensive preventive medicine evaluation and management service for a new patient aged 18-39 years.The service includes a detailed history appropriate for age and gender, a comprehensive physical examination, counseling and anticipatory guidance on risk factor reduction, and the ordering of appropriate laboratory and diagnostic tests.Immunizations are billed separately. If a significant, separately identifiable problem is addressed requiring additional work beyond the preventive medicine service, an additional E/M code (99202-99215) with modifier 25 should be reported.
Example 1: A 25-year-old female presents for her first visit to a new primary care physician. The physician performs a comprehensive history, physical exam, orders a lipid panel and Pap smear, discusses preventative health, and provides contraception counseling., A 32-year-old male presents for his annual physical with a new primary care physician.He has a history of hypertension well-controlled with medication. The physician reviews his medication list and blood pressure, performs a physical exam, orders routine labs, discusses healthy lifestyle choices, and counsels on stress management., A 19-year-old college student presents for her first visit to a new family physician. During the comprehensive preventive medicine visit, the physician orders a complete blood count (CBC), discusses healthy eating habits, and advises on responsible alcohol consumption and sexual health.
Detailed documentation of the history, physical examination, counseling provided, risk factor assessments, and any ordered lab/diagnostic tests.The record should clearly show that the patient is a new patient and falls within the 18-39 age range.
** This code should only be used for new patients aged 18-39 years.Immunizations, laboratory tests, and other procedures are billed separately with appropriate codes.Documentation must support the comprehensive nature of the visit.
- Revenue Code: M1A (Office Visits - New)
- Payment Status: Active
- Specialties:Family Medicine, Internal Medicine, and other specialties providing primary care.
- Place of Service:Office