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CPT 99385: Initial Preventive Visit for New Adult Patient, Ages 18–39
CPT code 99385 denotes an initial comprehensive preventive medicine evaluation and management visit for a new patient aged 18–39. This preventive visit establishes baseline health status, identifies risk factors, and facilitates age-appropriate screening and counseling. Nationally, preventive visits are central to primary care delivery, affecting preventive service utilization metrics, patient access to routine care, and payer coverage design.
Key payers included in this overview are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise description of the clinical purpose of the code, typical sites of service, commonly associated diagnosis pointers for preventive encounters, and the relevant peer codes used for comparisons across adult age bands. The analysis highlights how 99385 fits into the suite of preventive medicine codes for new patients and its relationship to periodic reevaluation codes for established patients.
This publication supplies practical reference material for billing and administrative teams and for policy analysts tracking preventive care coding. Topics covered include code definition and clinical context, common corroborating ICD-10 diagnosis options for preventive encounters, related CPT preventive codes for other age groups, and operational considerations for aligning preventive visits with payer coverage. Data not available in the input is indicated where applicable.
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Billing Code Overview
CPT code 99385 describes an initial comprehensive preventive medicine evaluation and management visit for a new patient aged 18 to 39. The service is a well-patient (preventive) visit focused on health promotion, risk assessment, preventive counseling, and development of a baseline preventive care plan.
Service type: Initial preventive medicine evaluation and management
Typical site of service: Office or outpatient clinic, where primary care physicians and specialties conduct comprehensive preventive evaluations for new adult patients.
National Reimbursement Benchmarks
National commercial rates for CPT 99385 center around BUCA’s average of $151.40, with individual payer means varying: Aetna ($155), Blue Cross Blue Shield ($144.80), Cigna ($147.90), and UnitedHealth Group ($177.90). Median and quartile comparisons show that Blue Cross Blue Shield and Cigna medians sit close to BUCA’s center, while UnitedHealth Group’s median of $159.10 and higher mean indicate upward skew in that payer’s distribution. Aetna and UnitedHealth Group exhibit higher maximum values, reflecting tail-end outliers above the BUCA average.
Dispersion measured by the interquartile range (P75 minus P25) highlights where rates are most concentrated: Blue Cross Blue Shield has a tight IQR of $43.70, and BUCA’s IQR is $69.20, indicating relatively narrow middle distributions. UnitedHealth Group shows the widest IQR at $100.40, followed by Cigna at $97.10 and Aetna at $117.90, signaling greater variability in contractual rates for those payers.