CPT 99385: Initial Preventive Medicine Exam, Adult 18–39
Commercial payers pay $151 on average nationally for this procedure.
CPT code 99385 describes an initial comprehensive preventive medicine evaluation and management visit for a new adult patient aged 18 to 39, typically performed as a well‑patient preventive visit that includes history, examination, and age‑appropriate counseling and risk assessment; service type: Initial comprehensive preventive medicine evaluation; typical site of service: office or outpatient clinic.
For related coverage guidance, see recent payer policy updates: Prolonged Services for Labor Management, Prolonged Services for Labor Management, Cervical Cancer Screening.
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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.