CPT Code 99385: Initial Preventive E/M, Age 18–39

Learn about CPT code 99385 and its significance for preventive visits. Gain essential insights for better healthcare practices. Read the article for guidance.

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What is an initial preventive visit for adults aged 18–39?

An initial preventive visit for adults aged 18–39 is an opportunity to establish baseline health data and address risk factors early. It’s typically scheduled when a patient is new to your practice or hasn’t had a preventive check in several years.

During this visit, you’ll take a comprehensive history, perform a physical exam, and offer personalized counseling and anticipatory guidance. It’s also a good time to discuss immunizations, lab tests, and lifestyle habits that can impact long-term health outcomes. Providers may also use this visit to assess whether the patient might qualify for ACP services.

One specific code is CPT code 99385 which refers to initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 18–39 years.

Accurate coding is essential for healthcare providers to receive appropriate reimbursement and to reflect the full scope of the medicine evaluation and management service delivered. It also supports documentation for preventive care, compliance, and long-term care planning.

CPT code 99385 documentation requirements

To ensure proper billing and support quality care, documentation must reflect all required components of the visit. Here's what you need to include:

Comprehensive history (personal, family, social, ROS)
Comprehensive physical exam
Preventive screenings (e.g., BMI, BP, depression)
Lifestyle counseling and anticipatory guidance
Screening test orders and review of immunizations

Do not include management of a significant problem unless billed separately with modifier -25.

CPT code 99385 billing guidelines

CPT code 99385 is used for a comprehensive preventive medicine service for new patients aged 18–39. This visit focuses on preventive services and is not intended to address acute or chronic health complaints.

The patient must be new to the provider or group practice.
The patient's age must fall within the 18–39 age range on the service date.
This code is for routine preventive services, not for visits addressing specific medical issues.
Include age-appropriate screening services, risk assessments, and anticipatory guidance.
If a separate problem-oriented E/M service is provided on the same day, a different code can be billed with modifier 25 attached.

Correct use of CPT 99385 supports proper reimbursement and ensures documentation and coding standards compliance. Always verify coverage requirements and frequency limits with the patient's insurance provider.

Other relevant preventive medicine CPT codes

There are other preventive medicine CPT codes you may use for different types of checkups, depending on the patient’s age and whether they’re a new or established patient. These codes help make sure preventive care is billed correctly for each specific visit.

Preventive visits new patients

These include initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures.

99381: Infant (age younger than 1 year)
99382: Early childhood (age 1 through 4 years)
99383: Late childhood (age 5 through 11 years)
99384: Adolescent (age 12 through 17 years)
99386: 40-64 years
99387: 65 years and older

Preventive visits established patient

These codes pertain to periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient.

99391: Infant (age younger than 1 year)
99392: Early childhood (age 1 through 4 years)
99393: Late childhood (age 5 through 11 years)
99394: Adolescent (age 12 through 17 years)
99395: 18-39 years
99396: 40-64 years
99397: 65 years and older

Frequently asked questions

CPT code 99385 is used for a comprehensive preventive visit for new adult patients. It includes taking a complete medical history, performing a physical exam, offering counseling on health risks and prevention, and conducting necessary screenings. This proactive checkup helps catch potential health issues early and maintain overall wellness.

This code applies to new patients between 18 and 39 years old. It’s meant for young adults, helping establish a baseline of care as they transition into adulthood.

The primary distinction is the patient’s status. CPT code 99385 is for new patients, meaning it’s their first preventive visit with that provider. In contrast, 99395 is for established patients—those who have had prior visits with the healthcare provider. Both codes are for preventive care but are based on the patient-provider relationship.