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CPT 99385

Excluded from PFS

99385 · PFS Q3 2018 · Historical

Status N: non-covered. Medicare covers no part of this service, so the PFS produces no payment amount.

View applicable payment rules
View CMS source and method

CPT 99385 has no published national rate. It carries status N (non-covered) in the Q3 2018 release. Medicare covers no part of this service. The blank amount means unpriced, not $0.

PFS status evidence

Physician relative value file (Q3 2018) · rvu18c1.zip (PPRRVU18_JUL.csv row 16,594)
Inspect PFS status evidence
Code
99385
Release
Q3 2018, revision 1
Result
Excluded from PFS

Citations

  • Shows this code’s PFS status (N). Result: Excluded from PFS.

    Physician relative value file (PPRRVU)

    Q3 2018 · revision 1

    Latest revision of this release

    Release period: July 1 – September 30, 2018

    This PFS record alone does not establish a $0 allowance or a coverage determination. Any amount from another schedule needs its own evidence.

    Record details PPRRVU18_JUL.csv in rvu18c1.zip (row 16,594)
    hcpcs (col 1)
    99385
    modifier (col 2)
    blank
    status_code (col 4)
    N

    SHA-256: 514e3c115f8e62a35eb5f78fef7ed12ed7b60b22a5fe3f3f1bb5aadf119663c5

    Original source file

Plain-text summary

Why is there no national PFS amount for 99385?

Its status indicator is N (non-covered). Medicare covers no part of this service. Status N: non-covered. Medicare covers no part of this service, so the PFS produces no payment amount.

What Medicare pays for instead of 99385 Copy link

Medicare covers its own preventive visits instead, under three G codes that the fee schedule does price. Which one applies depends entirely on how long the patient has had Part B and whether they have used the initial visit before.

Code When it applies Medicare amount
G0402 The Welcome to Medicare visit. This is the only one of the three billable during the patient's first 12 months of Part B coverage, and it is available once per lifetime. $169.92
G0438 The first annual wellness visit, billable once the patient has had Part B for more than 12 months. Once per beneficiary per lifetime — a claim from a previous practice uses it up, so check eligibility before billing it for a new patient. $175.32
G0439 Every annual wellness visit after the first. This is the code most established Medicare patients need each year. $119.16

Routine physical checkups are excluded from Medicare coverage by statute, which is why every preventive medicine visit code carries status N. CMS states the point directly: a preventive medicine service billed with these codes is a noncovered service, and providers are instructed not to bill annual wellness visits with them.

Being non-covered is not the same as being bundled: there is no Medicare payment for 99385 to fold into another service. What that means for billing the patient depends on why the code is not covered—services excluded by statute are treated differently from services ruled out by a coverage determination—and the status letter alone does not record which applies. How status indicators work covers the distinction.

Amounts computed from the Q3 2018 Physician Fee Schedule release, nationally (GPCI 1.000), in the Office (non-facility) setting, before the ~2% sequestration cut. Each code above was checked against that release before being shown here.

Payment considerations Copy link

Here are the inputs and payment rules that apply to this code. Each link takes you to the detail below.

Other payment indicators (10)

Facility/non-facility: Not determined, Professional/technical component: Does not apply, Bilateral adjustment: Does not apply, Multiple-procedure reduction: Does not apply, Assistant/co-surgeon treatment: Does not apply, Global surgery: Does not apply, NCCI same-day edits: Not determined, MUE behavior: Not determined, Other fee-schedule routing: Does not apply, Contractor pricing: Does not apply.

Why would a Medicare claim for 99385 be denied or paid less?

These come from CMS indicators on this page, not general billing advice.

  • Its status indicator is N (non-covered)—Medicare covers no part of this service. See status indicators

Payer-specific coverage and documentation rules live outside these files, so a claim that clears every check here can still be denied on other grounds.

Which billing rules and modifiers apply? Copy link

Global period: what 99385's fee already covers Copy link

XXX Does not apply

The global surgery concept does not apply to this code.

Can you bill it with another code? Copy link

Check a pair of codes Copy link

Enter a second CPT or HCPCS code billed on the same date of service. We'll check the current NCCI procedure-to-procedure edit for the pair.

See every current NCCI pair for 99385 →

How has it changed? Copy link

Rate history by release Copy link

National Office (non-facility) amount for 99385 across quarterly releases.

Release Status Office Facility
Q4 2026 takes effect Oct 1, 2026 N — —
Q3 2026 Jul 1, 2026 – Sep 30, 2026 N — —
Q2 2026 Apr 1, 2026 – Jun 30, 2026 N — —
When does this rate change?

CMS publishes a fee schedule release every quarter (January, April, July, October), and each is versioned here. See what changed each release, or get an email when a new release moves rates.

Sources: CMS Medicare Physician Fee Schedule Relative Value Files.

Usage and related codes Copy link

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Source & method

Show sources

This page uses CMS's Medicare Physician Fee Schedule Q3 2018 release (effective July 2018). National baselines use GPCI 1.000 and exclude sequestration. Whether a national amount exists depends on the status and CMS’s payment instructions; blank RVUs are never treated as zero. Past releases are never edited, so these sources stay valid after CMS publishes a newer one. Our methodology explains sourcing, parsing, versioning, and how we cross-check claims before we publish them.

Physician relative value file (Q3 2018) · rvu18c1.zip (PPRRVU18_JUL.csv row 16,594)

Use the (i) buttons next to each amount above for the exact row, columns, and math.

Cite this rate

The citation names the release, so anyone can check it even after CMS publishes a newer one.

CPT 99385 National PFS baseline: No national PFS rate (Q3 2018; participating; whole service; GPCI 1.000; sequestration excluded). Localis. https://localishealth.com/cpt/99385/2018/C