99385

Initial Preventive Medicine Evaluation, New Patient, 18-39 Years

CPT code 99385 is utilized for the initial comprehensive preventive medicine evaluation and management of an individual who is a new patient to the physician or group practice, specifically within the age range of 18 through 39 years. This encounter is fundamentally distinct from problem-oriented Evaluation and Management (E/M) services, such as codes 99202-99205. The primary focus of a 99385 visit is health promotion, disease prevention, and the identification of asymptomatic risk factors rather than the diagnosis or treatment of a specific acute or chronic illness. To satisfy the requirements of this code, the provider must perform an age- and gender-appropriate history and physical examination. The history component typically includes a comprehensive review of the patient's past medical history, family history, and social history, alongside a comprehensive review of systems. The physical examination is not restricted by the standard E/M bullet points but must be comprehensive as defined by the patient's age and risk profile. Furthermore, the service includes counseling, anticipatory guidance, and risk factor reduction interventions. For the 18-39 age cohort, this frequently involves discussions regarding nutrition, physical activity, substance use (tobacco, alcohol, and illicit drugs), sexual health and contraception, injury prevention (such as seatbelt use), and mental health screenings for depression or anxiety. The provider also oversees the ordering of laboratory or diagnostic procedures appropriate for the patient's age and risk factors, such as lipid screenings, cervical cancer screenings, or infectious disease testing. A 'new patient' is defined as one who has not received any professional services from the physician or another physician of the exact same specialty and subspecialty who belongs to the same group practice within the past three years.

Clinical Indications

  • Annual wellness examination for an asymptomatic adult aged 18-39
  • Comprehensive health risk assessment for a new patient
  • Screening for chronic diseases (e.g., hypertension, obesity, diabetes) in a young adult
  • Update of immunizations for a new patient (e.g., Tdap, HPV, Influenza)
  • Initial reproductive health counseling and screening for sexually active adults
  • Assessment of lifestyle-related risk factors including diet, exercise, and tobacco use

Procedure Steps

  1. Review and document the patient's comprehensive medical, family, and social history.
  2. Perform a multi-system, age-appropriate physical examination (e.g., height, weight, BMI, blood pressure, skin check, etc.).
  3. Perform screenings as indicated by gender and age (e.g., pelvic exam or testicular exam).
  4. Evaluate immunization status and administer or order necessary vaccines.
  5. Conduct risk factor interventions and provide anticipatory guidance based on the patient's lifestyle and history.
  6. Order appropriate screening laboratory tests (e.g., fasting lipid panel, glucose screening, or STI testing).
  7. Document all findings, counseling provided, and the preventive plan of care.

Coding Guidelines

  • Do not report 99385 for patients who have been seen by the same specialty/practice within the last 36 months; use 99395 for established patients.
  • If a significant, separately identifiable problem is addressed during the preventive visit, the appropriate E/M code (e.g., 99202-99205) should be reported with modifier 25.
  • Immunizations and the administration of vaccines are reported separately from the preventive medicine E/M service.
  • Screening tests (e.g., screening mammography, screening pap smear) are billed separately using the appropriate CPT or HCPCS codes.
  • 99385 is specific to the 18-39 age range; use 99384 for ages 12-17 or 99386 for ages 40-64.
  • Medicare does not generally recognize 99385; for Medicare 'Welcome to Medicare' or Annual Wellness Visits, use G0402, G0438, or G0439.

Associated ICD-10 Codes