CPT code 99395: Preventive visit, established, age 18-392026 Medicare rate & RVUs in California

CMS doesn’t publish an office rate for 99395 in California.

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

What 99395 covers

The service is a comprehensive preventive medicine reevaluation for an established patient age 18 through 39. A physician or other qualified clinician typically reports it in primary care or another outpatient setting for an adult wellness examination. It includes an age- and sex-appropriate history and examination, counseling about health risks and preventive care, and planning for appropriate screening or other preventive services. Selection depends on established-patient status and age range, not on a specific complaint or body system.

Medicare classifies this service as not covered, status N, and does not pay for the visit under this code. Report the code for the preventive service itself; a separately identifiable evaluation and management service for a problem may be reported when supported by documentation, with modifier 25 on the problem-oriented E/M code when appropriate.

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 99395 pays more and less in California

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

29 of 29 payment localities

How the 99395 rate is calculated

Each of 99395’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 99395

99395 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.

99395 compared with similar codes

How to choose

99385Preventive visitNew patient, age 18-39

99385 is the new-patient preventive service for ages 18 through 39; 99395 is for an established patient in the same age range.

99394Adolescent preventive visitEstablished, ages 12–17

99394 is the established-patient preventive visit for ages 12 through 17. Use 99395 for an established patient age 18 through 39.

99396Preventive visitEstablished, ages 40-64

99396 is for an established patient age 40 through 64. Use 99395 for an established patient age 18 through 39.

G0438Annual wellness visitInitial visit, first AWV

G0438 describes an initial Medicare Annual Wellness Visit, a distinct service from the comprehensive preventive medicine visit represented by 99395.

Codes related to 99395

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