Can 99213 and 99396 be billed together?
Asked by: Amalia Larson DVM | Last update: January 24, 2026Score: 4.3/5 (4 votes)
Can 99396 be billed with 99213?
The physician documents the extra work, then bills code 99396 for a periodic preventive medicine visit for a patient age 40–64 and E/M code 99213 for addressing two acute illnesses (fatigue and insomnia) and ordering two labs. The physician adds modifier 25 to the E/M code.
Can an office visit and preventive visit be billed together?
Physicians are not prohibited from coding and billing for both preventive and problem-focused E/M services when they are performed during the same appointment.
Can two E&M codes be billed together?
Yes, two E&M codes can be billed together if the services provided meet the necessary criteria for each code and are supported by appropriate documentation.
Can you bill 99395 and 99213 together?
can be used 99213 with 99395 at the same visit? Absolutely! You would use the modifier -25 on the 99213. Look at the Preventive Medicine section in CPT® and this is outlined in the narrative explanation prior to the actual listing of codes.
What is a level 3 or 2 office / outpatient visit in medical coding? 99213 & 99203 explained
What are the billing guidelines for CPT code 99396?
The billing guidelines for CPT Code 99396 include documenting medical necessity, accurately documenting the time spent during the visit, using appropriate modifiers for separate services, and obtaining consent or advance beneficiary notice (ABN) if applicable.
Does 99213 need a modifier?
Modifiers may be necessary for CPT code 99213 under certain circumstances, such as when billing for telehealth services or when other procedures are performed on the same day (e.g. Modifier 25). The specific modifier depends on the situation and payer requirements.
Can 99386 and 99213 be billed together?
From what I was informed in both my CPC and CPMA courses and training on the job, is that a provider can bill a 99386 (new patient CPE) and a 99213 (established patient level 3) on the same date of service.
Can you bill 99396 and G0439 together?
Don't bill CPT codes 99381-99397 (comprehensive preventive medicine evaluation and management services) for Medicare services covered by HCPCS codes G0402, G0438, and G0439.
Can you bill a procedure and office visit together?
The immediately preceding evaluation that leads to the recommendation of an office procedure can be billed on the same day as the procedure itself. Similarly, counseling and MDM that arise from the results of a procedure may take place immediately following it and are separately billable.
Does Medicare cover 99396?
As of January 1, 2021, CPT codes 99386 and 99396 will not be paid and will be denied. These codes are not on the Department of Health Care Services (DHCS) Medi-Cal fee schedule.
What is the difference between preventive visit and office visit?
The purpose of a preventive visit is to review your overall health, identify risks and find out how to stay healthy. Your plan covers 100% of a preventive visit when you see a doctor in your plan network. * The purpose of an office visit is to discuss or get treated for a specific health concern or condition.
What is the preventive visit modifier 25?
Modifier 25 is used to indicate that a patient's condition required a significant, separately identifiable evaluation and management (E/M) service above and beyond that associated with another procedure or service being reported by the same physician or other qualified health care professional (QHP) on the same date.
Can office visit and preventive visit be billed together?
Can Office and Preventive Visits be Billed Together? The short answer is yes. CPT® codes 99381-99397 are used for comprehensive preventive evaluations that are age-specific, beginning with infancy and ranging through patients 65 years and older, for both new and established patients.
What are the rules for CPT code 99213?
CPT Code 99213 Description:
Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three components to be present in the medical record: An expanded problem focused history. An expanded problem focused examination.
Can 99396 be done via telehealth?
Comprehensive prevention family planning visits are also covered via telemedicine/telehealth, billed with an FP modifier: CPT® 99384, 99385, 99386, 99394, 99395, 99396, 99401. Comprehensive prevention family planning visits will continue to be limited to once every 365 days.
Can you bill 99213 and 99396?
In this case, the clinician would report the appropriate preventive service visit (such as 99396) on one line of the claim form, followed by the problem-oriented E/M visit (such as 99213) with modifier 25 appended on the next line.
What are the requirements for 99396?
Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures; 40-64 years.
How do you bill two E&M on the same day?
If you see a patient in separate settings on the same date of service, you should not add the time together, even if you were accustomed to billing that way for years. Instead, you can report two separate E/M codes with modifier 25 appended.
Can you bill an AWV and E&M together?
The CMS website states “When you provide an annual wellness visit and a significant, separately identifiable, medically necessary Evaluation and Management (E/M) service, Medicare may pay the additional service. Report the additional CPT code with Modifier-25.
What modifier can be used with 99213?
In this case, you may submit codes for both a preventive service (such as 99396) and a regular office visit (such as 99213) by attaching -25 to the office-visit code.
What is the billing guideline for 99386?
CPT code 99386 signifies a comprehensive preventive medicine evaluation and management service for new patients. In the realm of preventive medicine services, this code is applied when healthcare providers engage in the in-depth assessment and management of new patients during preventive care encounters.
Is 99213 a preventive code?
However, if you bill an additional office visit code (for example, 15 minute expanded problem visit code 99213 with modifier 25), this is NOT considered a preventive service, and may be subject to deductibles, copays or coinsurance.
Can you bill 99213 and 20610 together?
Per CCI edits, CPT codes 20610-RT and 99213-25 cannot be billed together; however a modifier is allowed with supporting documentation.
When to use modifier 24 examples?
Use Modifier 24 on an E/M when: An unrelated E/M service is performed beginning the day after the procedure, by the same physician, during the 10 or 90-day post-operative period. Documentation indicates the service was exclusively for treatment of the underlying condition and not for post-operative care.