CPT 99395: Established Adult Periodic Preventive Visit (18–39 years)
Commercial payers pay $143 on average nationally for this procedure.
CPT code 99395 describes a periodic comprehensive preventive medicine reevaluation and management visit for an established patient age 18–39, typically delivered as an established adult preventive/wellness office visit that includes age‑appropriate history, examination, counseling, anticipatory guidance, and ordering of appropriate screening or diagnostic procedures; the service type is preventive medicine/periodic well‑patient visit and the typical site of service is an office or clinic outpatient setting.
For related coverage guidance, see recent payer policy updates: DRG Newborn Inpatient Stays - Facility, Pediatric Preventive Screening, Pediatric Preventive Screening.
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National Reimbursement Benchmarks
National commercial rates for CPT 99395 center around BUCA’s average commercial rate of $143.20, with individual payers showing meaningful differences in central tendency and spread. Blue Cross Blue Shield’s median of $132.70 and Cigna’s median of $127.80 sit slightly below BUCA’s mean, while UnitedHealth Group’s median of $145.40 is just above it; Aetna and Cigna present wider upper tails with maximums up to $385.00 and $359.70 respectively.
Dispersion measured as the interquartile spread (P75 minus P25) highlights where rates are most and least concentrated: Blue Cross Blue Shield is the tightest with a spread of $39.40, followed by BUCA at $64.20 and UnitedHealth Group at $92.90. The largest dispersion appears for Aetna at $104.70 and Cigna at $85.70, indicating more variability in allowable commercial rates across those payers.