CPT® Code 99385 is used to report an initial comprehensive preventive medicine evaluation and management (E/M) service for a new patient between the ages of 18 and 39. This service includes age- and gender-appropriate history, examination, counseling, anticipatory guidance, risk factor reduction interventions, and the ordering of appropriate immunization(s) and laboratory/diagnostic procedures. It is typically performed in a primary care or integrative health setting as part of a routine wellness visit.
This code applies when a new patient, defined as one who has not received any professional services from the provider (or another provider of the same specialty in the same group) within the past three years, is seen for a preventive visit rather than for a specific complaint or problem.
Key facts about CPT Code 99385
- Service type: Preventive (not problem-oriented)
- Patient type: New patient, ages 18–39
- Setting: Office or outpatient
- Includes:
- Comprehensive history and physical exam
- Counseling on lifestyle, nutrition, safety, reproductive health, etc.
- Ordering appropriate screenings and immunizations
- Does not include: Evaluation or treatment of acute or chronic health problems (which require separate problem-oriented E/M codes)
When to use CPT Code 99385
Use CPT 99385 for wellness visits when a patient aged 18–39 is new to your practice and presents for a routine preventive exam. This visit is focused on health maintenance and risk assessment, not on diagnosing or managing current illnesses.
If a separate problem is evaluated and treated during the same encounter, you may report an additional E/M code (e.g., 99203) with modifier -25, provided documentation supports both services.
Documentation requirements
Proper documentation for CPT 99385 must reflect:
- A comprehensive review of medical, family, and social history
- A full physical examination appropriate to the patient’s age and gender
- Discussion of:
- Health behaviors (e.g., smoking, alcohol use, exercise)
- Nutrition and weight management
- Sexual and reproductive health
- Preventive screenings (e.g., Pap smears, STI testing)
- Mental health and stress
- Any recommended lab work or immunizations
Accurate, detailed documentation ensures compliance, supports medical necessity, and protects against audit risk.
Reimbursement and coding considerations
CPT 99385 is generally covered by most commercial insurance plans under preventive benefits, often with no patient copay or deductible due to ACA mandates. However, some important billing tips include:
- Confirm whether the patient qualifies as a new patient
- Use appropriate ICD-10 preventive codes (e.g., Z00.00 or Z00.01)
- Bill separately for vaccines and lab tests using the appropriate codes
- Be cautious when adding other services—only bill additional E/M codes when medically justified and separately documented
Medicare does not reimburse 99385, as it uses G codes for its Annual Wellness Visits (AWVs).
How OptiMantra streamlines preventive care documentation
OptiMantra offers a comprehensive, customizable platform designed to support wellness-focused practices delivering preventive services like CPT 99385. With OptiMantra, providers can:
- Use tailored templates for preventive visits by age and gender
- Capture detailed patient histories and easily update records over time
- Automatically suggest screenings, labs, and immunizations based on patient profile
- Document counseling and anticipatory guidance in structured fields for billing accuracy
- Submit clean claims for preventive and problem-focused visits with appropriate modifiers
Whether you’re a primary care provider or part of a multidisciplinary wellness clinic, OptiMantra enables you to deliver complete, personalized care while minimizing administrative burden.
Try OptiMantra for free here!
