CPT code 99386: Preventive visit, new patient, age 40–642026 Medicare rate & RVUs

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

What 99386 covers

This code describes a comprehensive preventive evaluation for a new patient who is 40 through 64 years old. The clinician takes an age- and sex-appropriate health history, performs a preventive examination, and provides counseling or anticipatory guidance and risk-reduction interventions. Primary care clinicians commonly report it in an office or outpatient setting for a routine preventive visit, rather than an evaluation focused only on a new symptom or illness.

Medicare assigns this code physician fee schedule status N, meaning Medicare does not cover the service under this code. It represents the preventive visit as a whole, not a separately performed screening test or a time-based service. Select the age-specific code based on the patient’s age and whether the patient meets the CPT definition of new to the clinician or group. The established-patient counterpart for the same age range is 99396.

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 99386 pays more and less

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

109 of 109 payment localities

99386 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 99386 rate is calculated

Each of 99386’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 99386

99386 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.

99386 compared with similar codes

How to choose

99385Preventive visitNew patient, age 18-39

99385 is for a new patient age 18–39; 99386 is for a new patient age 40–64.

99387Preventive visitNew patient, age 65+

99387 is for a new patient age 65 or older. Use 99386 for ages 40–64.

99396Preventive visitEstablished, ages 40-64

99396 covers the same 40–64 age range but is for an established patient; 99386 is for a new patient.

99395Preventive visitEstablished, age 18-39

99395 is for an established patient age 18–39. For an established patient age 40–64, use 99396 instead.

Codes related to 99386

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