CPT code 99385: Preventive visit, new patient, age 18-392026 Medicare rate & RVUs in Florida

CMS doesn’t publish an office rate for 99385 in Florida.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 99385 covers

This code describes a comprehensive preventive medicine evaluation and management visit for a new patient ages 18 through 39. A physician or other qualified health professional typically provides it in an office or outpatient setting. The service includes an age- and gender-appropriate history and examination, preventive counseling or anticipatory guidance, risk-factor reduction, and ordering laboratory or diagnostic procedures as appropriate. It is distinct from an evaluation centered on a specific symptom or management of an active problem.

Medicare classifies 99385 as status N: Medicare does not cover the service under this code. The age range and new-patient status distinguish it from other preventive medicine visit codes. A patient generally qualifies as new when the patient has not received professional services from a physician or qualified health professional of the same specialty and subspecialty in the same group within the previous three years.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 99385 pays more and less in Florida

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

How the 99385 rate is calculated

Each of 99385’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for 99385

99385 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.

99385 compared with similar codes

How to choose

99395Preventive visitEstablished, age 18-39

Both are preventive visits for ages 18 through 39. Choose 99385 for a new patient and 99395 for an established patient.

99384Adolescent preventive visitNew patient, ages 12–17

This is the new-patient preventive code for ages 12 through 17; 99385 applies starting at age 18.

99386Preventive visitNew patient, age 40–64

This is the new-patient preventive code for ages 40 through 64; 99385 ends at age 39.

G0438Annual wellness visitInitial visit, first AWV

G0438 is Medicare's initial annual wellness visit, not a routine comprehensive physical. Medicare does not cover the preventive visit described by 99385.

Codes related to 99385

Related codes aren’t interchangeable: bill the code that matches the service performed.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates