Summary & Overview
CPT 99385: Initial Preventive Medicine Visit for New Adults
CPT 99385 denotes an initial comprehensive preventive medicine evaluation and management visit for new adult patients aged 18–39. Nationally, this code frames primary prevention encounters in outpatient office settings where clinicians perform age- and gender-appropriate histories and examinations, provide counseling and risk-reduction interventions, and arrange preventive laboratory or diagnostic testing. Its use signals an emphasis on health maintenance and early risk identification rather than problem-focused care.
Key payers included in the coverage context are Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare. Readers will find an overview of clinical and billing contexts for the code, common modifiers and associated ICD-10 diagnosis intents, and comparisons with related preventive E/M codes for other age groups and established patients. The publication outlines coding relationships to adjacent initial and periodic preventive medicine codes and highlights typical use in primary care specialties.
The content covers practical benchmarks for appropriate application of the code, common documentation elements that support code selection, and policy considerations relevant to payer coverage and preventive service designation. Where input data is missing, the report notes "Data not available in the input." Overall, the piece serves as a concise reference for clinicians, coding professionals, and policy stakeholders seeking clarity on the clinical scope and administrative context of CPT 99385 nationwide.
CPT Code Overview
CPT 99385 describes an initial comprehensive preventive medicine evaluation and management visit for a new patient aged 18–39 years. The service includes an age- and gender-appropriate history, physical examination, counseling and anticipatory guidance, risk-factor reduction interventions, and ordering of appropriate laboratory or diagnostic procedures. This code is used for preventive care encounters focused on health promotion and disease prevention rather than problem-focused evaluation.
Service type: Preventive medicine evaluation and management
Typical site of service: Office (e.g., physician office setting)
Clinical & Coding Specifications
Clinical Context
A 28-year-old new patient presents to a primary care office for a routine preventive visit. The patient schedules an initial comprehensive preventive medicine evaluation with a Family Medicine physician in an outpatient office setting. The visit includes an age- and gender-appropriate comprehensive history, a complete physical examination, counseling and anticipatory guidance (including risk factor reduction and lifestyle counseling), and ordering of screening laboratory and diagnostic tests as appropriate. The visit is documented as a new patient preventive encounter and may result in a diagnosis of Z00.00 (no abnormal findings) or Z00.01 (with abnormal findings) depending on findings. If a routine gynecological exam is performed with or without abnormal findings, Z01.411 or Z01.419 may be recorded. The clinical workflow typically includes pre-visit intake (forms, medication list), in-person evaluation by the physician, documentation of preventive counseling and ordered screening tests, and placement of orders for labs or imaging in the electronic health record. Billing uses the preventive medicine initial comprehensive E/M code 99385 for a new patient aged 18–39 years in the office.
Coding Specifications
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25— Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service: Use when a distinct E/M service (beyond the preventive visit content) is documented and meets E/M requirements on the same calendar day as another procedure or visit. Documentation must support the separate, significant evaluation and management. -
— Preventive service: Use to indicate that the service is a preventive care service as defined by payors. This modifier is applied when the visit is billed as a preventive service to facilitate appropriate payer processing.