What Is CPT Code 99386?
CPT 99386 is the procedure code for an initial comprehensive preventive medicine evaluation and management of a new patient aged 40 through 64 years. It covers the age-appropriate and gender-appropriate history, physical examination, counseling, anticipatory guidance, risk factor reduction interventions, and the ordering of laboratory or diagnostic procedures that make up a complete preventive visit. CPT 99386 is a new patient code, meaning the patient has not been seen by any provider of the same specialty within the same group practice in the past three years.
New patient, age 40-64: 99386 applies to new patients in the 40 to 64 age bracket. Established patients in the same age range use 99396.
Comprehensive by definition: This is a complete preventive visit, not a problem-focused exam. The documentation must cover the full scope of age-appropriate screening, counseling, and risk assessment.
Not the same as Medicare’s AWV: Medicare does not cover 99386. Medicare beneficiaries receive the Annual Wellness Visit (G0438/G0439) instead. Billing 99386 to Medicare will deny.
When to Bill CPT 99386
Family medicine practices bill CPT 99386 when a new patient between the ages of 40 and 64 presents for a comprehensive preventive visit, commonly called an annual physical or wellness exam. The visit must include a comprehensive history covering past medical, family, and social history; a complete head-to-toe physical examination; age-appropriate screening recommendations; counseling on risk factors such as diet, exercise, tobacco use, and alcohol use; and the ordering of any indicated laboratory or diagnostic tests.
The most common clinical scenario is a new patient establishing care with a family medicine practice and scheduling their first physical. That initial preventive visit is coded under the 9938X series based on the patient’s age. For the 40 to 64 age range, the correct code is 99386. For patients 18 to 39, it is 99385. For patients 65 and older, the code is 99387, but this code is virtually never billed to Medicare because Medicare uses the Annual Wellness Visit codes instead.
One question we hear constantly from family medicine practice managers is whether 99386 can be billed alongside a problem-oriented E/M code on the same date. The answer is yes, when the provider identifies and addresses a problem that is separately identifiable from the preventive visit. The E/M code requires modifier 25 and must be supported by its own documentation. A patient who comes in for a physical and mentions knee pain that the provider evaluates and treats can support both 99386 and an E/M code such as CPT 99213 with modifier 25. For higher-complexity problem visits paired with a preventive exam, see our guide on CPT code 99214.
How Does 99386 Compare to Other Preventive Visit Codes?
The preventive medicine E/M code family is organized by patient status (new versus established) and age bracket. Here is the full grid for the age ranges family medicine practices see most often.
| CPT Code | Age Range | Patient Status | Visit Type | 2026 Medicare |
|---|---|---|---|---|
| 99385 | 18-39 years | New | Preventive | Not covered |
| 99386 | 40-64 years | New | Preventive | Not covered |
| 99387 | 65+ years | New | Preventive | Not covered |
| 99395 | 18-39 years | Established | Preventive | Not covered |
| 99396 | 40-64 years | Established | Preventive | Not covered |
| 99397 | 65+ years | Established | Preventive | Not covered |
| G0438 | Medicare beneficiaries | First AWV (new) | Wellness | ~$175 |
| G0439 | Medicare beneficiaries | Subsequent AWV | Wellness | ~$125 |
The critical distinction for family medicine billing is that Medicare does not cover the 9938X or 9939X preventive visit codes. Medicare beneficiaries receive the Annual Wellness Visit (G0438 for the initial, G0439 for subsequent) instead. Billing 99386 or 99396 to Medicare will deny. Commercial payers and Medicaid plans do cover the preventive visit codes, typically at $150 to $250 for a new patient visit depending on the contracted rate.
Across the billing companies we vet for family medicine practices, the 99386-to-Medicare error is one of the most common and most preventable denials. The front desk schedules a new patient physical, the EHR defaults to the 9938X code, and the claim goes to Medicare, which denies it. The fix is a front-desk workflow that flags Medicare patients for AWV coding before the encounter, not after the denial.
What Does CPT 99386 Reimburse in 2026?
Medicare does not cover CPT 99386. The preventive visit codes (99381-99397) are not Medicare-covered services. Medicare beneficiaries receive the Annual Wellness Visit under G0438 or G0439 instead.
Commercial payer reimbursement for 99386 typically ranges from $175 to $280 for the new patient preventive visit, depending on the contracted rate and the geographic market. Most commercial plans cover one preventive visit per year at no cost to the patient under the ACA preventive care mandate, which means there is no copay, coinsurance, or deductible applied when the visit is coded correctly as preventive. However, if a problem-oriented E/M code is billed alongside 99386 with modifier 25, the problem visit portion may be subject to the patient’s cost-sharing.
Providers often come to us after discovering that their practice has been billing 99396 (established patient) on patients who were actually new to the practice. A patient transferring from another provider who has not been seen by anyone in the group within three years is a new patient and should be coded under 99386, which reimburses higher than 99396. The new patient premium is typically $30 to $50 per visit, and a practice that miscodes even three new patients per week as established loses $4,500 to $7,500 per year in preventive visit revenue alone.
Preventive visit codes are where family medicine practices lose the most revenue to simple coding errors: billing Medicare for a service it does not cover, coding new patients as established, and failing to capture a separately billable problem visit with modifier 25. A family medicine billing partner who catches these before claims go out recovers more than the service costs. Family Med Billers connects family medicine practices with vetted billing companies, free.
Common 99386 Billing Mistakes
These are the errors that cost family medicine practices the most revenue on new patient preventive visit claims.
1. Billing 99386 to Medicare. Medicare does not cover preventive visit codes. Medicare patients receive the Annual Wellness Visit (G0438 or G0439). This is the single most common preventive visit denial in family medicine.
2. Coding a new patient as established. A patient not seen by any provider of the same specialty in the group within three years is new. Billing 99396 instead of 99386 forfeits $30 to $50 per visit.
3. Not billing a separately identifiable problem visit. When the provider evaluates and treats a new problem during the preventive visit, the problem visit can be billed with an E/M code and modifier 25. Missing this leaves the problem-visit revenue uncollected.
4. Insufficient preventive documentation. A 99386 note must include a comprehensive history, full physical exam, age-appropriate screening, and counseling. A focused note that reads like a problem visit does not support the preventive code.
5. Wrong age bracket code. A 38-year-old new patient is 99385, not 99386. A 66-year-old new patient on a commercial plan is 99387, not 99386. The age on the date of service determines the code.
6. Billing the preventive visit and a comprehensive E/M (99205) on the same date. The preventive visit already includes a comprehensive exam. Stacking a high-level E/M on top without a genuinely separate problem invites audit and denial.
Documentation Requirements for 99386
In our experience matching family medicine practices with billing partners, preventive visit claims deny most often for documentation that does not match the comprehensive scope the code requires. Every 99386 note should include a complete past medical history, family history, and social history; a review of systems covering at least 10 organ systems; a complete head-to-toe physical examination; age-appropriate screening recommendations (cancer screening, cardiovascular risk, diabetes screening for patients 40-64); counseling on risk factors including diet, exercise, tobacco, alcohol, and mental health; and any laboratory or diagnostic orders with their clinical rationale.
The documentation must reflect a preventive visit, not a problem-focused encounter. A note that opens with a chief complaint and documents a focused evaluation reads like an E/M visit and will be downcoded if audited. The preventive visit note should open with the reason for the visit stated as a routine physical or preventive evaluation, followed by the comprehensive history and exam. If a problem is addressed during the visit, it should be documented separately in a distinct section of the note to support the modifier-25 E/M claim. To see how the 2027 Medicare changes affect family medicine reimbursement broadly, read our breakdown of the 2027 family medicine Medicare payment changes.
Frequently Asked Questions
What is CPT code 99386?
CPT 99386 is the code for an initial comprehensive preventive medicine evaluation of a new patient aged 40 through 64 years. It covers the complete history, physical examination, counseling, risk assessment, and ordering of age-appropriate screening and diagnostic tests.
Does Medicare cover CPT 99386?
No. Medicare does not cover the preventive visit codes (99381-99397). Medicare beneficiaries receive the Annual Wellness Visit under G0438 (initial) or G0439 (subsequent). Billing 99386 to Medicare will result in a denial.
What is the difference between 99386 and 99396?
CPT 99386 is for new patients aged 40-64. CPT 99396 is for established patients in the same age range. A new patient has not been seen by any provider of the same specialty in the same group within the past three years. 99386 reimburses higher because of the additional work required for new patient encounters.
Can I bill 99386 with an E/M code on the same date?
Yes, if the provider identifies and documents a separately identifiable problem during the preventive visit. The E/M code requires modifier 25 and must be supported by its own documentation. A patient who comes in for a physical and has a new problem evaluated can support both codes.
What diagnosis code supports 99386?
The primary ICD-10 code for a preventive visit is Z00.00 (encounter for general adult medical examination without abnormal findings) or Z00.01 (with abnormal findings). If the provider identifies a problem during the visit, the problem-specific diagnosis supports the separately billed E/M code.
How much does 99386 reimburse?
Commercial payer reimbursement for 99386 typically ranges from $175 to $280 for the new patient preventive visit. Most commercial plans cover one preventive visit per year at no cost to the patient under the ACA mandate. Medicare does not cover this code.
Next Steps
For E/M codes that pair with preventive visits using modifier 25, see our guides on CPT 99214 and CPT 99213.
To see how 2027 Medicare changes affect family medicine, read our 2027 payment changes breakdown.
If your billing team is sending preventive visit codes to Medicare or miscoding new patients as established, get matched with a family medicine billing partner who catches these before they cost you.
Preventive visits are the foundation of family medicine revenue, and the coding errors are predictable: Medicare denials on 99386, new patients coded as established, and problem visits left unbilled when modifier 25 applied. Family Med Billers connects family medicine practices with vetted billing companies that code preventive visits correctly and capture every dollar the visit earned. Across all 50 states, with rates starting as low as 2.95%. Comparing quotes is 100% free for providers.
