Summary & Overview
CPT 99387: Initial Comprehensive Preventive Medicine Evaluation for Seniors
CPT code 99387 represents the initial comprehensive preventive medicine evaluation and management for new patients aged 65 years and older. This code is nationally significant as it supports preventive care for seniors, encompassing a thorough history, physical examination, counseling, and risk factor reduction interventions. The service is typically provided in an office setting and is a cornerstone of preventive medicine, aiming to identify health risks and promote wellness among older adults.
Major payers covering this code include Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare. The publication provides insights into payer coverage, clinical context, and policy updates relevant to 99387. Readers will learn about benchmarks for preventive medicine services, recent changes in payer policies, and the clinical importance of comprehensive preventive evaluations for seniors. The analysis also highlights related codes for other age groups and periodic reevaluations, offering a broader perspective on preventive medicine billing and coding practices.
This summary serves as a resource for understanding the role of 99387 in preventive care, its coverage by leading payers, and its place within the broader landscape of evaluation and management services for older adults.
CPT Code Overview
CPT code 99387 is used for the initial comprehensive preventive medicine evaluation and management of a new patient aged 65 years and older. This service includes an age and gender appropriate history, physical examination, counseling, anticipatory guidance, risk factor reduction interventions, and the ordering of laboratory or diagnostic procedures. The typical site of service for this evaluation is an office setting, such as place of service 11. This code is part of preventive medicine and evaluation and management services, focusing on promoting health and preventing disease in older adults.
Clinical & Coding Specifications
Clinical Context
A new patient aged 65 years or older presents to a primary care office for an initial comprehensive preventive medicine evaluation. The visit includes a detailed age- and gender-appropriate medical history, a thorough physical examination, counseling on health maintenance, anticipatory guidance, risk factor reduction interventions, and the ordering of laboratory or diagnostic procedures as indicated. The provider may be a family medicine or internal medicine specialist. The encounter is focused on prevention and wellness, not on acute or chronic illness management.
Coding Specifications
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Modifier
33: Used to indicate that the service provided is preventive in nature, as defined by relevant payor policies. This modifier is commonly appended to preventive medicine codes to ensure proper adjudication by payors. -
Modifier
25: Used when a significant, separately identifiable evaluation and management service is performed by the same physician on the same day as another procedure or service. This modifier may be used if a distinct E/M service is provided in addition to the preventive visit.
| Provider Taxonomy Code | Specialty |
|---|---|
207Q00000X | Family Medicine |
207R00000X | Internal Medicine |
Related Diagnoses
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Z00.00: Encounter for general adult medical examination without abnormal findings- Used when the preventive visit does not reveal any abnormal findings. Relevant for routine wellness exams.
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Z00.01: Encounter for general adult medical examination with abnormal findings- Used when the preventive visit identifies abnormal findings. Relevant for documenting preventive visits where issues are discovered.
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Z01.411: Encounter for gynecological examination (general) (routine) with abnormal findings- Used for preventive gynecological exams in women aged 65 and older when abnormal findings are present.
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Z01.419: Encounter for gynecological examination (routine) without abnormal findings- Used for preventive gynecological exams in women aged 65 and older when no abnormal findings are present.
Related CPT Codes
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99385: Initial comprehensive preventive medicine evaluation and management of an individual, new patient; 18‑39 years. Used for younger adults in a similar preventive context. -
99386: Initial comprehensive preventive medicine evaluation and management of an individual, new patient; 40‑64 years. Used for middle-aged adults in a similar preventive context. -
99391: Periodic comprehensive preventive medicine reevaluation and management of an individual, established patient; infant. Used for established infant patients for periodic preventive visits. -
99395: Periodic comprehensive preventive medicine reevaluation and management of an individual, established patient; 18‑39 years. Used for established adult patients in this age range for periodic preventive visits. -
99396: Periodic comprehensive preventive medicine reevaluation and management of an individual, established patient; 40‑64 years. Used for established adult patients in this age range for periodic preventive visits. -
99397: Periodic comprehensive preventive medicine reevaluation and management of an individual, established patient; 65 years and older. Used for established patients aged 65 and older for periodic preventive visits.
These codes are related by age group and whether the patient is new or established. Codes for new patients (99385, 99386, 99387) are used for initial preventive visits, while codes for established patients (99391, 99395, 99396, 99397) are used for periodic reevaluations. Only one code is used per visit, depending on patient status and age.
National Reimbursement Benchmarks
Nationally, the mean rate for CPT code 99387 among BUCA (average commercial) payers is $179.49, which is substantially higher than the Medicare rate. Commercial payers such as UnitedHealth Group and Cigna show even higher mean rates, with UnitedHealth Group at $229.76 and Cigna at $200.77.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies across payers. Aetna has the tightest range at $74.27, while UnitedHealth Group exhibits the widest spread at $127.00. This indicates that UnitedHealth Group's contracted rates for this code are more variable compared to Aetna's.
The table and chart below present the full breakdown of national benchmarks for each payer, including mean rates and percentile values.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.