CPT
90471 — Immunization administration, single vaccine
ACA-covered vaccines should be free, including the admin fee.
Preventive care
99395 — Periodic preventive exam, established patient 18-39
Annual preventive exam for established patient ages 18-39. Should be fully covered by ACA-compliant insurance.
- Typical setting: Doctor's office
- National avg charge (illustrative): Insurance allowed $130-$220; cash $150-$350. ACA: $0 patient cost.
- Most-disputed reason: Charged a copay or coinsurance when it should be $0 under ACA.
What it means
What 99395 actually means
CPT 99395 is the annual preventive medicine exam for established patients ages 18-39. Under ACA-compliant insurance, this is required to be covered at $0 cost-share when billed correctly.
The most common dispute is when the practice adds a separate problem-focused E/M code (99213/99214) on top of the preventive code. This 'problem-on-top-of-physical' billing creates a copay where there shouldn't be one.
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).
- A separate office visit code (99213) added when an issue came up during the physical, generating a copay.
- Preventive screening services unbundled when they should be free.
- Coded with a non-preventive diagnosis, defeating ACA $0 coverage.
If you see 99395 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 99395 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 99395 on a bill.
99395 FAQ
Plain-English answers.
Why am I being charged for my 'free' physical?
The most common reason: your provider added a problem-focused E/M code on top of the preventive code, which made part of the visit non-preventive. Ask the practice to re-code if the discussion was incidental.
Don't pay 99395 blindly.
The free scan tells you in under 60 seconds whether this charge looks reasonable for your situation.