CPT Code 99386: Initial Preventive E/M, New Patient, Age 40–64

CPT code 99396 is used for a comprehensive preventive medicine evaluation and management service provided to established patients aged 40 to 64 years. It covers an annual wellness visit that includes detailed medical history, comprehensive physical examination, counseling, screenings, and risk assessment tailored to this age group to promote disease prevention and health maintenance.

Medicare generally covers preventive services like annual wellness visits. Still, CPT code 99386, for new patients aged 40-64, may have specific coverage criteria depending on the Medicare plan and should be verified with the payer.

CPT codes 99386 and 99204 cannot typically be billed together for the same encounter because 99386 is a preventive medicine service for new patients, while 99204 is an evaluation and management code for new patient office visits with a problem focus; billing both without proper modifiers or distinct services risks claim denial due to overlapping services.