Preventive visit · CPT 99396

What is CPT code 99396?

Routine annual wellness visit, adult age 40-64 (established patient).

By Justin Feldstein · Reviewed 2026-06-15

What it covers

This is the routine annual physical or wellness visit for an established adult patient between 40 and 64. It's the same kind of preventive checkup as the younger-adult code, just for this age band: an age-appropriate exam, a health-history review, counseling, and ordering the age-relevant screenings that become more common in your 40s, 50s, and early 60s. Like other preventive visits, it's typically covered in full by insurance and is not meant for diagnosing or managing a specific complaint.

When you'd see it

You'll see this after your yearly physical with your primary care provider once you're 40 or older (and under 65), the annual visit focused on staying healthy rather than treating a problem.

Roughly what it costs

$175–$450 commonly billed

A ballpark on the billed amount. After insurance or a negotiated rate, what you owe is often far lower. Always compare against your Explanation of Benefits (EOB).

What's usually billed with it

Age-appropriate screenings and lab panels ordered at the physical are billed under their own codes, which is routine; the line to watch is a separate sick or problem-focused office visit on the same date.

99396 vs 99395

The split is purely by age, so 99395 covers 18-39 and 99396 covers 40-64; the visit itself is the same routine wellness check. See 99395 (Preventive 18-39).

What to watch for

If your routine physical comes back with an added office-visit charge, ask billing to identify the separate, separately documented problem that justified it; a wellness visit alone should not generate a problem-visit fee, so it's a fair charge to question.

Specific things to question

• A covered annual physical billed as (or together with) a problem-focused office visit like 99214, frequently with a modifier 25, which can leave you owing for a visit you expected to be free.
• Mentioning a small ongoing issue during the physical converted into a separately billed problem visit.
• An age-band coding mismatch (for example 99395 or 99397 used instead of 99396) causing a denial.

How to check this charge on your own bill

Find 99396 on your itemized bill and match it against your EOB. Confirm it appears only once, that any bundled services aren't also billed separately, and that the amount matches what your insurer says it allowed. If something doesn't line up, that's a fair question for the billing office.