CPT code 99386: Preventive visit, new patient, age 40–642026 Medicare rate & RVUs in Texas
A comprehensive preventive evaluation for a new patient age 40–64, including age-appropriate history, examination, counseling, and risk-reduction guidance.
CMS doesn’t publish an office rate for 99386 in Texas.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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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 in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin, TX | Unavailable | Unavailable |
| Beaumont, TX | Unavailable | Unavailable |
| Brazoria, TX | Unavailable | Unavailable |
| Dallas, TX | Unavailable | Unavailable |
| Fort Worth, TX | Unavailable | Unavailable |
| Galveston, TX | Unavailable | Unavailable |
| Houston, TX | Unavailable | Unavailable |
| Rest of Texas | Unavailable | Unavailable |
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.
How the rate is built · 99386
RVUs × geographic indexes × conversion factor
Work2.33
2.33 RVUs× 1.000 GPCI
Practice expense2.18
2.18 RVUs× 1.000 GPCI
Malpractice0.15
0.15 RVUs× 1.000 GPCI
Adjusted RVUs
4.6600
Conversion factor
$33.4009
Medicare rate
$155.65
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
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.
Place of service · 99386
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
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99386 isn’t priced in this setting.
99386 compared with similar codes
Compare codes · National
5 codes, side by side
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.
99386 billing questions
How does 99386 differ from 99396?
Both describe preventive visits for patients age 40–64. Use 99386 for a new patient and 99396 for an established patient.
How is new-patient status determined?
For CPT reporting, a patient is new if the patient has not received professional services from the physician or another qualified health professional of the same specialty and subspecialty in the same group within the preceding three years.
Which age range belongs to 99386?
Use it for a patient age 40 through 64. For a new patient age 18–39, the corresponding age-band code is 99385; for age 65 or older, it is 99387.
Does Medicare cover 99386?
No. Medicare physician fee schedule status N identifies this service as not covered by Medicare under this code.
What should the record support?
Document the preventive history and examination, counseling or risk-reduction guidance provided, the patient’s age, and the basis for new-patient status.
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
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