| Category | Amount |
|---|---|
| Medicare Allowed Rate What Medicare approves for this service | $117.81 |
| Typical Billed Amount What providers commonly charge | $175 – $400 |
| Potential Markup How much more you might pay vs. Medicare rate | 240% above Medicare |
What CPT Code 99395 Means
CPT code 99395 represents a comprehensive preventive medicine visit for established patients aged 18-39 years. This is your standard annual physical exam - the yearly checkup you schedule to stay on top of your health even when you're feeling fine.
Your doctor uses this code when they perform a thorough evaluation that includes reviewing your medical history, conducting a physical examination, discussing preventive care like vaccinations or screenings, and addressing any health maintenance needs. The visit focuses on prevention rather than treating specific symptoms or illnesses.
This code is specifically for patients who have an established relationship with the healthcare provider, meaning you've been seen by this doctor or practice before. If you're a new patient getting your first physical at this practice, a different code (99385) would be used instead.
What to Expect on Your Medical Bill
When you receive your medical bill or explanation of benefits, you'll see CPT code 99395 listed for your annual physical. The Medicare reimbursement rate for this service is $117.81, but most healthcare providers charge significantly more than Medicare pays.
Typical charges for CPT code 99395 range from $175 to $400, depending on your healthcare provider and geographic location. The actual amount you pay depends on your insurance coverage - many insurance plans cover annual preventive visits at 100%, meaning you may owe nothing out of pocket.
If additional services were performed during your visit, such as lab work, vaccinations, or addressing specific health concerns, you may see additional CPT codes on your bill. These services may have separate charges and different coverage rules than your preventive exam.
How to Verify Your Billing is Correct
To check if you were billed correctly for CPT code 99395, first confirm that you're between ages 18-39 and that this was indeed an annual preventive visit with an established provider. If you're outside this age range or if this was your first visit to the practice, a different code should have been used.
Review your bill to ensure the charge falls within the typical range of $175-$400. If the charge seems unusually high, contact your healthcare provider's billing department to request an itemized explanation of the services provided.
If you believe you were incorrectly billed - for example, if preventive services were coded as diagnostic visits, or if you were charged for services you didn't receive - contact your healthcare provider's billing office first. Keep records of your communications and don't hesitate to involve your insurance company if you need help resolving billing disputes.