CPT Code 99386: Initial Comprehensive Preventive Medicine Evaluation (New Patient, 18–39 Years)

CPT 99386 describes: 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.

Clarification

The source description ("Emergency department visit...") is incorrect. 99386 is a preventive medicine code for new patients aged 18–39 in an office/outpatient setting. Emergency department E/M codes are 99281–99285.

Key Components (Per CPT & ACA)

• History: Comprehensive—past medical, surgical, family, social, psychosocial, immunization, medication, allergy, ROS (all systems).
• Exam: Comprehensive—all organ systems relevant to age/gender.
• Counseling/Anticipatory Guidance: Diet, exercise, substance use, sexual health, injury prevention, mental health, screening recommendations.
• Screening Orders: Lipids, glucose, STI, cervical cancer (if applicable), immunizations per ACIP.
• Risk Factor Reduction: Smoking cessation, weight management, PrEP counseling, etc.

Billing Rules

• Report once per lifetime per patient (initial preventive visit).
• Do not bill with problem-oriented E/M (99202–99215) unless a significant, separately identifiable problem is addressed (add modifier 25).
• No copay/coinsurance for ACA-compliant plans (preventive mandate).
• Use ICD-10 Z00.00 (general adult exam) or Z00.01 (with abnormal findings).

Age-Specific Variants

• 99381: <1 year
• 99382: 1–4 years
• 99383: 5–11 years
• 99384: 12–17 years
• 99385: 18–39 years (this code)
• 99387: 40–64 years
• 99387: ≥65 years