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CPT Codes For Adult Well-Being Screening (2022)

Adult screening is provided for patients older than 21 years of age. These services are provided to prevent and detect diseases, disabilities, or other health conditions. Below are the CPT codes you can use to bill adult health screening.

1. What Is CPT Code 99385?

CPT 99385 covers a procedure in which a provider performs a well-patient visit for a patient between 18 and 39 years old.

TIP: You can find the complete billing guide for CPT 99385 here.

1.1 Description

The CPT book describes CPT 99385 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; 18-39 years.”

1.2 Age Limit

The age limit of CPT code 99385 is 39 years. Bill this code only for patients between 18 and 39 years of age.

2. What Is CPT Code 99386?

The 99385 CPT code covers a well-patient visit by a provider for patients between the ages of 40 and 64.

TIP: You can find the complete billing guide for CPT 99386 here.

2.1 Description

The CPT book defines CPT code 99386 as follows: “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.”

2.2 Age Limit

CPT 99386 can only be used for a well-patient visit for patients not older than 64 years of age and no younger than 40 years of age.

3. What Is CPT Code 99387?

CPT 99387 can be billed or well-patient visits for new patients aged 65 years or older.

3.1 Description

The CPT book defines the official description of CPT 99387 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; 65 years and older.”

3.2 Age Limit

The 99387 CPT code can only be billed for new patients of 65 years or older.

4. What Is CPT Code 99395?

CPT 99395 covers a well-patient visit for an established patient between 18 and 39 years of age.

TIP: You can find the complete billing guide for CPT 99395 here.

4.1 Description

The CPT book defines CPT code 99395 as follows: “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; 18-39 years.”

4.2 Age Limit

The 99395 CPT code has an age limit of 39 years. Use this code only for established patients between 18 and 39 years of age.

5. What Is CPT Code 99396?

The 99396 CPT code can be billed for a well-patient procedure for established patients aged 40 to 64.

5.1 Description

The CPT book describes CPT code 99396 as: “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; 40-64 years.”

5.2 Age Limit

CPT 99396 can only be billed for established patients not older than 64 years of age. This well-patient visit may be used for patients aged 40 to 64.

6. What Is CPT Code 99397?

The 99397 CPT code can be billed for well-patient visits of established patients of 65 years or older.

TIP: You can find the complete billing guide for CPT 99397 here.

6.1 Description

CPT 99397 is defined by the CPT book as: “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; 65 years and older.”

6.2 Age Limit

You can only bill CPT code 99397 for established patients of 65 years or older.

7. Resources

CPT Professional 2022

https://www.mass.gov/doc/proposed-regulation-date-filed-october-15-2021-11/download

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