Summary & Overview
CPT 99395: Periodic Preventive Visit for Established Adult (18–39)
CPT code 99395 represents a periodic comprehensive preventive medicine reevaluation and management visit for an established adult patient aged 18–39. Nationally, this code captures routine well-care visits focused on prevention, age-appropriate screening, counseling, and health maintenance for younger adults. Its proper use affects preventive care delivery metrics, quality reporting, and primary care revenue streams across outpatient settings.
Key payers analyzed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical intent and coding context, payer coverage considerations, and how 99395 relates to adjacent preventive codes for other age groups. The publication covers common billing scenarios, documentation elements tied to preventive services, and comparisons to related codes for adolescents and older adults.
This summary is intended for practice managers, coding and billing staff, and policy analysts working at a national level. It outlines where 99395 is used, what clinicians must document for a comprehensive preventive visit, and how the code fits into broader preventive care workflows. Data not available in the input are noted where applicable in the full publication.
Billing Code Overview
CPT code 99395 describes a periodic comprehensive preventive medicine reevaluation and management visit for an established adult patient aged 18–39. This service involves an age-appropriate history, physical examination, counseling, anticipatory guidance, risk-factor reduction interventions, and when appropriate the ordering of laboratory or diagnostic procedures.
Service Type: Established patient preventive medicine visit
Typical Site of Service: Outpatient office or clinic visit
Clinical & Coding Specifications
Clinical Context
A 28-year-old established patient presents to her primary care physician for a routine annual well adult visit. The patient has no acute complaints and schedules this visit for preventive care, immunization review, screening needs, and counseling on lifestyle and reproductive health. The clinical workflow begins with medical assistant intake (vital signs, height/weight, medication list, and brief screening questionnaires). The provider performs an age-appropriate history and focused review of systems, completes a physical examination, reviews preventive screening status (including cervical cancer screening if indicated), updates immunizations, provides counseling/anticipatory guidance (nutrition, exercise, sexual health, contraception, tobacco/alcohol counseling), and orders or schedules indicated laboratory or screening tests. The encounter is coded as 99395 for an established patient aged 18–39 when documentation supports a comprehensive preventive medicine evaluation and management visit. Typical sites of service are office or outpatient clinic, occasionally performed in an ambulatory surgery center or community health clinic depending on practice setting.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
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 problem-focused visit or procedure is performed in addition to the preventive service on the same day and documentation supports a separate E/M |
| 24 | Unrelated E/M service by the same physician during a postoperative period | Use when a postoperative visit unrelated to the original procedure occurs during a global period (rare for routine preventive visits)
| 59 | Distinct procedural service | Use when another service or procedure provided on the same day is distinct and separate from 99395 and cannot be reported with an anatomical modifier
| 25 | Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service | Use when a problem-oriented E/M is documented in addition to the preventive visit on the same day
| 26 | Professional component | Use when reporting only the physician’s professional component of a separately billable diagnostic test ordered at the preventive visit
| TC | Technical component | Use when billing only the technical component of a diagnostic test performed in the facility associated with the visit
| 21 | Prolonged services | Use when prolonged face-to-face services are performed that meet payer criteria for additional reporting beyond standard preventive visit time
| 95 | Synchronous telemedicine service rendered via real-time interactive audio and video | Use when the preventive visit is delivered via live interactive telehealth modalities and payer accepts telemedicine for preventive E/M
| GT | Via interactive audio and video telecommunications systems (Telehealth) | Use for telehealth delivery when payer recognizes this modifier instead of 95
| 25 | Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service | Use when both preventive and problem-oriented E/M are clearly documented (repeated here for emphasis when relevant)
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207Q00000X | Family Medicine Physician | Commonly provides comprehensive preventive medicine visits for adults including counseling and screenings |
| 207R00000X | Internal Medicine Physician | Provides adult-focused preventive care, chronic disease prevention, and appropriate screening
| 208000000X | Pediatrics Physician | May see older adolescents transitioning to adult care; relevant for late-teen to young-adult preventive visits
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
Z00.00 | Encounter for general adult medical examination without abnormal findings | Primary preventive visit diagnosis when no abnormal findings are present at the well visit |
| Z00.01 | Encounter for general adult medical examination with abnormal findings | Use when new abnormal findings are identified during the preventive exam that may require further evaluation
| Z01.411 | Encounter for gynecological examination (general) (routine) with abnormal findings | Report when routine gynecologic screening performed during the visit identifies abnormal findings
| Z01.419 | Encounter for gynecological examination (general) (routine) without abnormal findings | Use when routine gynecologic exam is performed during the preventive visit and no abnormalities are found
| Z13.89 | Encounter for screening for other disorder | Use for specific screening purposes initiated at the preventive visit (for example, targeted laboratory or risk-based screening)
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
99394 | Periodic comprehensive preventive medicine reevaluation and management of an adolescent (age 12–17 years), established patient | Alternative age-specific preventive visit for younger patients; used when patient age falls into adolescent bracket instead of 99395 |
| 99396 | Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient | Used for established patients aged 40–64; represents the next age band after 99395 for care planning and coding
| 99397 | Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient | Used for established patients aged 65 and older; represents the older-age preventive visit code following 99395