Is a physical at urgent care covered by insurance?
It depends on which physical. Most plans pay for one preventive exam a year at no cost in network, and 99385 is that yearly exam for a new patient age 18 to 39. Sports, camp, DOT and pre employment physicals are a different story: most plans exclude them, and most urgent cares price those as cash instead.
Depends
Preventive yes, sports and DOT no
Age banded
99385 fits ages 18 to 39 only. A 15 year old is 99384 and a 45 year old is 99386, and the wrong band denies on age alone.
Once a year
One preventive visit per 12 months on most plans. If the primary care office already used it, urgent care collects nothing for the same code.
Cash for forms
Sports, camp, DOT and pre employment exams are excluded by nearly every plan. Collect the flat cash price at the desk instead of billing and losing it.
Modifier 25
A real complaint found during the physical bills as a second visit with modifier 25. Verify the plan before rooming so the extra copay is no shock.
What would a real check show for this patient's 99385?
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Eligibility readout · 99385
Sample- Coverage
- Active, preventive covered in full
- Frequency
- One preventive visit every 12 months
- Patient share
- Type your fee to see it
Estimate from a sample plan. A real check reads the actual plan in under a second.
When 99385 is the right code
- Patient is 18 to 39 years old
- New to the practice, not seen in three years
- Comprehensive preventive exam, no presenting complaint
- Not a sports, camp, DOT or work form
- The yearly preventive benefit is still unused
Documentation payers expect
Payers expect a preventive diagnosis, a full age appropriate exam and history in the note, and the patient's date of birth on the claim. If a problem is handled the same day, that visit needs its own note, its own diagnosis and modifier 25.
Why a physical at urgent care gets denied
What happens after the physical
Physicals generate follow ups. Labs ordered at the exam bill on their own lines and can hit the deductible even when the exam itself was free. If a complaint came up, a problem visit such as 99213 is added with modifier 25 and the copay applies. Vaccines, a TB blood test under 86480 or a work form each carry separate rules. Pulling plan status and the deductible left beforehand is what keeps a free physical from becoming a surprise bill.
99385, quick answers
Is my annual physical really free?
On most plans the preventive visit itself is covered in full in network, once every 12 months. Labs and anything treated the same day are billed separately.
Does Medicare cover a yearly physical?
No. Medicare does not pay for a routine physical exam. It covers a Welcome to Medicare visit in the first year and an annual wellness visit after that, which are different services with their own codes.
Why did urgent care charge me for a sports physical?
Sports, camp and work exams sit outside what nearly every plan covers, so urgent cares collect a flat cash price rather than bill insurance for them.
Can urgent care do my yearly physical instead of my doctor?
Some plans pay the preventive benefit only at an in network primary care office. Have the desk confirm coverage and any referral flag before the appointment.
Why was there a copay on top of a free physical?
A problem addressed during the exam is billed as a second, separate visit with modifier 25. That line carries the normal copay or coinsurance.
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Related: 99384 · 99395 · 99203
CPT is a registered trademark of the American Medical Association. This page is Valian's own plain-English summary for front-desk teams, not official CPT descriptor text, and is not billing or clinical advice. Coverage patterns are common plan behaviors; every plan differs. Verify benefits before the visit.