Preventive visit, established patient, age 40–64
Your annual physical/wellness exam if you're between 40 and 64 and have been seen at the practice before.
Based on typical US negotiated and cash-pay rates. Hospital charges can run significantly higher — often 2–10x these numbers. If your bill is well above this range, it's worth questioning.
- A copay or coinsurance applied — most ACA plans cover this 100% in-network.
- Additional E&M code (99213/99214) billed alongside without a truly separate problem addressed.
If your insurer applied cost-sharing to preventive care, appeal citing the ACA preventive services benefit.
Frequently asked questions
What does CPT code 99396 mean?
Your annual physical/wellness exam if you're between 40 and 64 and have been seen at the practice before. In billing terms it's categorized as "Preventive visit, established patient, age 40–64" under Preventive.
How much should CPT 99396 cost?
Typical negotiated and cash-pay rates run about $180–$350. Hospital list prices are often 2–10× higher, but insurers rarely pay those. If your bill is well above the top of this range, ask for an itemized bill and compare.
Is CPT 99396 covered by insurance?
Most commercial plans and Medicare cover preventive visit, established patient, age 40–64 when it's medically necessary and coded correctly. Denials usually come from missing prior authorization, incorrect modifiers, or the payer disputing medical necessity — all of which can be appealed.
What should I do if CPT 99396 looks wrong on my bill?
If your insurer applied cost-sharing to preventive care, appeal citing the ACA preventive services benefit.
Can I dispute a charge for CPT 99396?
Yes. You have the right to request an itemized bill, dispute the coding with the provider's billing office, and appeal the insurer's decision. Federal rules (including the No Surprises Act for emergency and out-of-network ancillary services) protect you from many surprise charges. BillCheck can generate the appeal or negotiation letter for you.
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BillCheck provides informational analysis only and is not legal, medical, or financial advice. Verify all details before submitting any correspondence to insurers or providers. Prices shown are typical ranges and vary by region, payer, and facility.