CPT 99386: Preventive Visit, New Patient, Age 40-64
Initial comprehensive preventive medicine evaluation and management of a new patient, age 40 through 64 years.
Why CPT 99386 Claims Get Denied
Claims billed under CPT 99386 are frequently denied or downcoded for the following reasons. Understanding these patterns helps your practice reduce denial rates and recover revenue faster.
Annual visit frequency exceeded
Preventive and problem visit not properly separated
Missing preventive diagnosis code
Plan does not cover comprehensive physical exams
Billing Tips for CPT 99386
Include age-appropriate screenings (lipids, glucose, cancer screenings). Bill separately for any problems addressed with modifier 25. Document all USPSTF-recommended screenings offered or performed.
Documentation Requirements
To support a clean claim for CPT 99386, your clinical documentation should include:
Comprehensive history with risk factor review
Complete multi-system examination
Cancer screening discussion and orders
Cardiovascular risk assessment
Immunization review
Counseling on diet, exercise, and health maintenance
Common Modifiers for CPT 99386
Reduce CPT 99386 Denials by 60%
RediClaim's pre-submission scrubber catches documentation gaps and coding errors before you submit, while the appeal generator handles denials that slip through.