CPT® Code 99386 is used to report an initial preventive medicine evaluation and management (E/M) service for new patients aged 40 to 64 years. This code represents a comprehensive wellness visit focused on health risk assessment, age-appropriate screenings, counseling, and preventive guidance—rather than the diagnosis or management of existing conditions.
This visit is not problem-focused. Instead, it emphasizes proactive, whole-person care, designed to identify risks early and promote long-term wellness.
Key facts about CPT® Code 99386
- Service type: Preventive E/M visit
- Patient type: New patient, age 40–64
- Purpose: Routine health check, screening, and counseling
- Includes:
- Age/gender-appropriate history and physical exam
- Risk assessment and preventive counseling
- Ordering of appropriate labs or tests
- Health education and anticipatory guidance
- Excludes:
- Evaluation or treatment of existing medical conditions
- Follow-up for chronic issues (requires separate E/M coding)
When to use CPT Code 99386
Use CPT 99386 when a new patient aged 40–64 presents for a comprehensive preventive exam with no specific complaint or illness requiring evaluation. This visit should be focused on:
- Early detection of risk factors (e.g., hypertension, obesity, cancer risks)
- Health screenings (e.g., mammograms, cholesterol, diabetes)
- Lifestyle counseling (e.g., smoking cessation, diet, exercise)
- Review of immunization status and preventive recommendations
If a new or existing condition is addressed beyond what’s expected in a preventive exam, it may be appropriate to add a problem-focused E/M code (e.g., 99203) with modifier -25, if supported by documentation.
Documentation requirements
To ensure proper billing and compliance for CPT 99386, the provider should document:
- Complete medical and family history, with age-appropriate detail
- Thorough physical exam tailored to the patient’s gender and age
- Review and ordering of screenings and labs
- Risk factor assessment and related guidance (e.g., cardiovascular risk)
- Patient counseling on lifestyle, screenings, and preventive care
- Duration of the visit (if payer requires time documentation)
Be sure to distinguish preventive care from problem-based care if billing multiple services during the same encounter.
Reimbursement and coding considerations
CPT 99386 is generally covered by commercial insurance plans as part of annual preventive care benefits, often with no cost-sharing to the patient under ACA-compliant plans. However, coverage may vary by plan, and Medicare does not cover 99386—instead offering the Welcome to Medicare visit (G0402) and Annual Wellness Visits (G0438/G0439).
Coding tips:
- Use ICD-10 code Z00.00 (general adult exam without abnormal findings) or Z00.01 (with abnormal findings)
- If a problem-focused service is provided, bill the additional E/M code separately with modifier -25
- Be sure to check payer guidelines for frequency and bundling rules
How OptiMantra supports preventive care visits like 99386
OptiMantra is built to help integrative, functional, and primary care practices maximize the value and efficiency of preventive services like CPT 99386. From intake to billing, the platform streamlines every step:
- Customizable preventive visit templates ensure all documentation requirements are met
- Built-in screening tools for lifestyle, mental health, and chronic risk factors
- Automated reminders and recall for annual wellness visits
- Seamless E/M code pairing and modifier support
- Integrated billing workflows for clean claims and fast reimbursement
With OptiMantra, providers can offer comprehensive, whole-person preventive care while reducing administrative burden and improving reimbursement accuracy.
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