CPT
90471 — Immunization administration, single vaccine
ACA-covered vaccines should be free, including the admin fee.
Preventive care
99396 — Periodic preventive exam, established patient 40-64
Annual preventive exam for established patients 40-64. ACA: $0 cost-share when billed correctly.
- Typical setting: Doctor's office
- National avg charge (illustrative): Insurance allowed $150-$250; cash $200-$400. ACA: $0 patient cost.
- Most-disputed reason: Problem-focused code added on top, generating a copay.
What it means
What 99396 actually means
CPT 99396 is the annual preventive medicine exam for established patients 40-64. ACA-compliant plans must cover this at $0 cost-share.
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 E/M (99213/99214) tacked on, creating a copay.
- Lab work coded as diagnostic instead of preventive screening, triggering cost-share.
- Coded with a non-preventive primary diagnosis.
If you see 99396 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 99396 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 99396 on a bill.
99396 FAQ
Plain-English answers.
Can my doctor add a 99213 to my physical?
Only if a significant separate problem was addressed that required its own evaluation. If the doctor just answered a quick question during the physical, the 99213 add-on is debatable and worth disputing.
Don't pay 99396 blindly.
The free scan tells you in under 60 seconds whether this charge looks reasonable for your situation.