CPT 99386 is an annual preventive exam for a new patient aged 40 to 64: history, examination, risk counseling and ordering of screening tests such as cholesterol, colon cancer screening and mammography. Insured patients usually pay nothing for the visit itself under preventive-care rules; the cash price applies to everyone else.
What the price covers
The visit only. Laboratory tests, an ECG, vaccines and any imaging are separate codes. A problem raised during the visit may be billed as a second, problem-oriented visit on top of the preventive one.
Why prices vary
Ownership decides most of it: hospital-owned practices add facility fees, independent practices generally do not. Cash prices for a physical at this age typically run from around $150 to several hundred dollars.
Questions to ask
- What is the self-pay price for 99386, and is there a facility fee?
- Which screening tests will be ordered, and what will each cost?
- Will discussing an existing condition add a second visit charge?