CPT 99385
Global XXXPrev visit new age 18-39
CPT 99385 Billing & Documentation Guide
CPT code 99385 (Prev visit new age 18-39) is classified under E/M with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 1.92, a non-facility practice expense RVU of 1.99, and a malpractice RVU of 0.12, a total non-facility RVU of 4.03 and facility RVU of 2.46. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $138.24, though rates vary from $123.29 to $169.19 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 99385, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 99385 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Non-covered service
No global period (E/M and other non-procedural services)
MUE Limit (Medically Unlikely Edits)
Submitting more than 0 units of 99385 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 99385
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.92 | 1.92 |
| Practice Expense RVU | 1.99 | 0.42 |
| Malpractice RVU | 0.12 | 0.12 |
| Total RVU | 4.03 | 2.46 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 99385
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $147.25 | $85.2 | $140.22 - $169.18 | 29 |
| Florida | $138.62 | $86.01 | $133.7 - $143.46 | 3 |
| Georgia | $132.44 | $82.41 | $128.2 - $136.67 | 2 |
| Illinois | $136.24 | $85.57 | $131.08 - $140.58 | 4 |
| Michigan | $132.19 | $82.94 | $129.34 - $135.03 | 2 |
| North Carolina | $128.71 | $79.78 | $128.71 - $128.71 | 1 |
| New York | $146.77 | $88.27 | $130.09 - $154.71 | 5 |
| Ohio | $128.85 | $80.98 | $128.85 - $128.85 | 1 |
| Pennsylvania | $134.1 | $82.74 | $128.93 - $139.26 | 2 |
| Texas | $133.64 | $82.02 | $128.34 - $138.13 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 99385
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 99385 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0359T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0360T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0361T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0362T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0363T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0364T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0365T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0366T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0367T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0368T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 99385
What does CPT code 99385 mean? +
CPT code 99385 represents: Prev visit new age 18-39. It's in the E/M category with a global period of XXX.
What is the Medicare reimbursement for CPT 99385? +
The 2026 Medicare national average non-facility payment for CPT 99385 is $138.24. Rates range from $123.29 to $169.19 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 99385? +
E/M codes commonly use modifier 25 (significant separately identifiable E/M on same day as a procedure), 57 (decision for major surgery), 24 (unrelated E/M during global period), 95 (synchronous audio+video telehealth), 93 (audio-only telehealth), and AI (principal physician of record on admission). Surgical modifiers like 50, 51, 59 do not apply to E/M.
What bundling edits apply to CPT 99385? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
Get the full PayerReady toolkit
Free access to CPT/ICD-10 lookup, denial appeals, fee comparator, and claim auditing with credentialing enrollment.
Start free →Run this code through our claim audit tool
Check NCCI bundling, MUE limits, and modifier logic before submission.
Try the auditor →Did this page help?
Quick signal so we know what to improve.
If you want a code reference page that doesn't exist yet, email coding@payerready.com.
Tell us what's missing or wrong: coding@payerready.com. We respond within 5 business days.
Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
Powered by 11K CPT · 98K ICD-10 · 860K MPFS rates · 4.5M NCCI edits · 9.5M NPIs. Our data methodology · About our coding team