CPT
90471 — Immunization administration, single vaccine
ACA-covered vaccines should be free, including the admin fee.
Preventive care
99385 — New patient preventive exam, ages 18-39
First preventive exam with a new provider, ages 18-39. ACA: $0 cost-share.
- Typical setting: Doctor's office
- National avg charge (illustrative): Insurance allowed $150-$250; cash $200-$400. ACA: $0 patient cost.
- Most-disputed reason: Same as 99395 — problem-focused add-on creating cost-share.
What it means
What 99385 actually means
CPT 99385 is the new-patient preventive exam for ages 18-39. ACA-compliant plans cover this at $0 patient cost.
Common errors with this code
What goes wrong on real bills.
Most bills that look correct still contain at least one of these issues. Up to 49% of medical bills contain errors (CFPB).
- Problem-focused code added when an incidental issue was discussed.
- Screening labs coded as diagnostic, generating a copay.
If you see 99385 on your bill
Three steps before paying.
1. Get the itemized bill. If your statement only shows a summary, request the CPT-level itemized bill before paying. Generate the request language →
2. Cross-check against the EOB. Compare what your insurer's Explanation of Benefits says you owe versus what the hospital is asking. They disagree more often than people think. Read the bill-vs-EOB guide →
3. Run a free Bill Scan. Upload the bill (and EOB if you have it) and BillBusted will flag the most likely issues with this specific code in your specific state. Run free scan →
Related codes
Other codes in this category.
People who land on 99385 often also see these adjacent codes on the same bill.
CPT
90472 — Immunization admin; each additional vaccine
Vaccine — admin (90471) is separate from the vaccine product code.
CPT
90651 — Human papillomavirus vaccine types 6, 11, 16, 18, 31, 33, 45, 52, 58, nonavalent , IM
Vaccine — admin (90471) is separate from the vaccine product code.
CPT
90670 — Pneumococcal conjugate vaccine, 13 valent , IM
Vaccine — admin (90471) is separate from the vaccine product code.
CPT
90671 — Pneumococcal conjugate vaccine, 15 valent , IM
Vaccine — admin (90471) is separate from the vaccine product code.
CPT
90677 — Pneumococcal conjugate vaccine, 20 valent , IM
Vaccine — admin (90471) is separate from the vaccine product code.
Related BillBusted guides
Plain-English reads if you see 99385 on a bill.
99385 FAQ
Plain-English answers.
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