Procedure · Updated Aug 1, 2026

Annual physical: CPT code and Medicare rate

A comprehensive preventive exam for a patient who has been seen before, billed by the patient's age band — 99397 for age 65 and over, 99396 for ages 40 to 64.

Also called: yearly physical, annual exam, routine physical, preventive exam.

Usually billed as

99397 Preventive Exam, Established Patient, Age 65+

99397 has no national Medicare amount in the Q3 2026 release — its status is non-covered. What Medicare pays depends on the circumstances of the individual claim.

Traditional Medicare does not cover a routine annual physical. It covers the Annual Wellness Visit (G0438/G0439) instead, which is a different service — a health-risk review and prevention plan rather than a head-to-toe exam.

Related codes

Codes worth checking before you settle on 99397.

Code	What it covers	Office	Facility
99396	Preventive Exam, Established Patient, Age 40-64	—	—
G0439	Annual Wellness Visit, Subsequent	$137.61	$137.61
G0438	Annual Wellness Visit, Initial	$174.35	$174.35

A dash means the code has no national amount in this release — it may be carrier-priced, bundled, or not separately payable. That is never the same as $0.

Common questions

Annual physical: which code is it?: 99397 — Preventive Exam, Established Patient, Age 65+. A comprehensive preventive exam for a patient who has been seen before, billed by the patient's age band — 99397 for age 65 and over, 99396 for ages 40 to 64.
Annual physical: how much does Medicare pay?: 99397 has no national Medicare amount in the Q3 2026 release — its status is non-covered. What Medicare pays depends on the specific circumstances of the claim.
Annual physical: what else affects the billing?: Traditional Medicare does not cover a routine annual physical. It covers the Annual Wellness Visit (G0438/G0439) instead, which is a different service — a health-risk review and prevention plan rather than a head-to-toe exam.

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This page maps everyday language to the code a claim normally carries. It is general information about how Medicare prices a service, not coding advice for a specific claim — the correct code always depends on what was actually documented and performed.

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