Periodic comprehensive preventive medicine, age 18-39
Audit Defense & Denial Intelligence
Research-based denial patterns from OrbDoc Bill Analyzer
1. Frequency limit - annual preventive visit billed too frequently
CommonInsurance plans typically cover one preventive visit per calendar year. Billing 99395 twice in 12 months triggers denial of second visit.
Common Causes
- • Patient had preventive visit <12 months ago
- • Confusion between calendar year and 365-day coverage periods
- • Patient changed insurance and had visit under previous plan
Resolution Strategy
Verify date of previous preventive visit. If within coverage period, patient responsibility. If error, provide documentation showing >12 months since last visit.
💬 Plain Language Explanation
What this means
This is a preventive medicine visit for an established patient - a routine check-up or annual physical exam.
Why you might see this
This is a common code for annual physicals or routine check-ups. You might see this for your yearly preventive care visit, which is often fully covered by insurance without copays or deductibles.
Common context
Common code for annual physicals or routine preventive care visits, usually fully covered by insurance.
What to ask your provider
"'Was this my annual physical? Is this fully covered by my insurance as preventive care?'"
Who are you?
Code Details
Medicare Pricing
PFSRVU Breakdown
OPPS Details
Automate Coding
Let OrbDoc AI automatically suggest codes from your clinical notes.
Patient? Check your bill.
Use our free analyzer to understand charges and spot errors.
Analyze My BillAsk OrbDoc AI
Get instant answers about 99395 - pricing, bundling rules, or billing questions.
Ask a QuestionRelated Solutions & Resources
Primary Care Solutions
Optimize documentation for office visits and improve workflow efficiency
Primary Care Setup Guide
Complete guide for configuring AI medical scribe in primary care practices
Medicare Billing Optimization
Capture AWV, TCM, CCM, RPM revenue with accurate documentation
Surgical Documentation
Accurate procedure documentation for surgical centers
Frequently Asked Questions
CPT 99395 is the billing code for "Periodic comprehensive preventive medicine, age 18-39". It falls under the Evaluation & Management category and is used by healthcare providers to bill insurance for this specific service.
Medicare pays approximately $113.86 for CPT 99395 (national average). Actual payment varies by geographic location due to GPCI adjustments. Hospital and commercial insurance rates are typically 2-4x higher than Medicare rates.
The most common denial reason for CPT 99395 is "Frequency limit - annual preventive visit billed too frequently". Insurance plans typically cover one preventive visit per calendar year. Billing 99395 twice in 12 months triggers denial of second visit. Common causes include: Patient had preventive visit <12 months ago; Confusion between calendar year and 365-day coverage periods. Appeal success rate is approximately 10-30%.