99386 CPT Code (2023) | Description, Guidelines, Reimbursement, Modifiers & Examples

CPT code 99386 can be used for adults between 40 and 64 for an initial comprehensive preventive medicine evaluation and management (also known as well-patient).


Patients with no primary complaint can benefit from evaluation and management services, also known as E/M services, which are part of preventive medicine.

A patient’s overall health is far more critical to evaluate during a visit than any illness or injury (or the signs or symptoms of a disease or injury).

The CTP code 99386 can use by a physician who thoroughly examines the patient. The billing-related topics, such as coding, compliance, and documentation, can be discussed in CPR’s “Coding Corner.” 

As the managing editor of AAPC, an organization that provides education and credentials to healthcare professionals, John Verhovshek has this month’s hint to share with our readers.

Codes will assign by taking into account the patient’s age and whether they are new (99381-99387) or established (99381-99387) patients into consideration (99391-99397). Companies can be classified as either new or appointed based on the “three-year rule,” according to CPT guidelines. 

Description Of The 99386 CPT Code

The CPT manual describes CPT 99386 as: “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; 40-64 years”

CPT code 99386 specifies an initial comprehensive evaluation and management for preventive medicine, including all of these components. In addition, it includes screening for adolescent scoliosis and growth and vaccination assessments.

The prostate, penis, scrotum, and testes can examine by males of any age. It is possible to do this during an elderly patient’s examinations.

The doctor can inquire about the patient’s occupation and other family-related topics during the consultation

PSA testing can become more critical as patients get older. Patients are not required to pay a co-payment for preventive services under the Patient Protection and Affordable Care Act (PPACA).

Insurance policies and reporting requirements can differ from one company to the next. It can confirm by CPT Assistant. 

If a particular E/M service performs on the same day as chemotherapy or non-chemotherapy injections or infusions, a new patient’s CPT 99386 must include CPT modifier 25.

The 99381-99397 E/M reporting codes include children, adolescents, and adults.

As a patient’s age increases, so do the scope and intensity of services provided. The E/M department offers various preventive services to women over 28. One of these services is a pelvic exam. 

Billing Guidelines

Reporting for breast exams with CPT code 99386 is inappropriate because they can be part of a comprehensive preventive medicine E/M service. Third-party payers can require a different method of writing these services.

Preventive medication can usually prescribe to new patients who meet the criteria for an age-based code selection after completing a thorough physical examination. One of these services is the examination, which includes gathering relevant patient history. 

Preventive inspections are not required to report minor or self-limiting issues or complaints if the necessary E/M components are available to the clinician when a problem-oriented E/M service is unavailable. 

You may use modifier 25 with CTP code 99386. Modifier 25 could be helpful in diagnostic or surgical procedures as a preventative measure.

Modifier 25 can be used for the 99386 CPT code to indicate preventive services when test results can use in diagnostic or therapeutic benefits on the same day as a screening service. The Affordable Care Act was a direct cause of this change.

Preventative services evaluations can generate reports like assessments of other services that can create accounts. MDM is the most likely problem assessment code used in this situation.

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