Annual Physical - New Patient, Age 40-64
CPT Code: 99386
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What does the Medicare rate mean?
The Medicare rate of $207.57 is the amount the federal government pays providers for CPT 99386under the Medicare Physician Fee Schedule. It’s the most widely published benchmark for what a procedure "should" cost and is used as a reference point by commercial insurers when negotiating their own rates.
What do commercial insurers pay?
Commercial insurers (Blue Cross, Aetna, UnitedHealth, etc.) negotiate rates independently with each provider network. As a rule of thumb, these rates fall in the $249.08 – $415.14 range for Annual Physical - New Patient, Age 40-64 — roughly 1.2 to 2 times Medicare. If you were billed significantly more, the excess may be negotiable.
What if I was billed more than the commercial range?
Bills above the typical commercial range are common, especially for uninsured or out-of-network patients who receive chargemaster (list) prices. You have several options:
- Ask for the Medicare rate or self-pay discount — many providers will accept this immediately.
- Request an itemized bill — billing errors are common and can account for hundreds or thousands of dollars.
- Appeal if you have insurance — if the procedure was denied or you were billed out-of-network, you have the right to appeal.
- Ask about financial assistance — nonprofit hospitals are required by law to offer charity care programs.
How preventive care charges like this are billed
Under the Affordable Care Act, a defined list of preventive services — annual wellness visits, many screenings, and routine immunizations — must be covered at no cost to you when delivered in-network. When a preventive visit generates a bill, the cause is usually a coding issue rather than a real charge.
Common billing problems with preventive care charges
Preventive visit converted to a diagnostic one
If you mention a new symptom during a wellness visit and the provider addresses it, the visit can be partly recoded as diagnostic (problem-oriented), which is cost-shared. Ask whether a diagnostic E/M code was added and whether it was truly separate from the preventive service.
Wrong diagnosis code attached to a screening
A screening test billed with a diagnostic (rather than screening) diagnosis code can flip a $0 preventive service into a cost-shared one. This is a coding correction your provider can make and resubmit.
Out-of-network preventive care
The no-cost-sharing rule applies to in-network preventive care. If the provider or lab was out-of-network, preventive protection may not apply.
How to push back on this charge
Preventive billing disputes are usually won by correcting the diagnosis or visit code, not by negotiating a discount. Ask your provider's billing office to review whether the service qualifies as ACA-preventive and to resubmit if it was miscoded.
Frequently asked questions
How much does Annual Physical - New Patient, Age 40-64 cost without insurance?
Without insurance, you may be billed the chargemaster (list) rate, which can be 3–10× the Medicare rate. For Annual Physical - New Patient, Age 40-64, that could mean a bill of $622.71–$1,037.85 or more. Always ask for the self-pay or cash-pay rate before accepting the listed price — providers often offer significant discounts.
What is CPT code 99386?
CPT 99386 is the Current Procedural Terminology code assigned to Annual Physical - New Patient, Age 40-64. It’s used by providers, insurers, and Medicare to identify and bill for this specific service. You’ll find it on your Explanation of Benefits (EOB) or itemized bill.
Can I negotiate the cost of Annual Physical - New Patient, Age 40-64?
Yes. Negotiating medical bills is common and often successful. Referencing the Medicare rate of $207.57 gives you a credible, federally published benchmark to anchor the conversation. Many providers will accept 1–1.5× Medicare as a cash settlement.