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CPT Codes For Adult Screening (2021)


An adult health screening is performed by a physician to assess the health status of a Medicaid recipient age 21 and older. It is used to detect and prevent disease, disability and other health conditions or monitor their progressions. This is an all-inclusive service. No separate billing for required or recommended components is allowed.

CPT Procedure Codes For Adult Health Screening

Medicaid reimburses adult health screening services for recipients age 21 and older with the following procedure codes and no modifier.


  • CPT 99385: Under New Patient Preventive Medicine Services (for new patient screenings age 21-39)
  • CPT 99386: Under New Patient Preventive Medicine Services (for new patient screenings age 40-64)
  • CPT 99387: Under New Patient Preventive Medicine Services (for new patient screenings age 65 years and older)
  • CPT 99395:Under Established Patient Preventive Medicine Services (for established patient screenings age 21-39)
  • CPT 99396: Under Established Patient Preventive Medicine Services (for established patient screenings age 40-64)
  • CPT 99397: Under Established Patient Preventive Medicine Services (for established patient screenings age 65 years and older)

Reimbursement

Medicaid will reimburse for one adult health screening every 365 days. Adult health screenings are recommended for:

  • Age 21 through 39, one screening every five years.
  • Age 40 and over, one screening every two years.

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