Can I bill 99213 and 99401 together?
Asked by: Gussie Pagac | Last update: August 19, 2025Score: 4.1/5 (36 votes)
Can a CPT 99401 be billed with 99214?
Yes, you can bill CPT 99214 and 99401 together, provided that the services rendered meet the criteria for each code. CPT 99401 should be utilized for preventive counseling specifically related to obesity management, while CPT 99214 covers the office visit with moderate medical decision-making.
What is the billing rule for 99401?
For example, the time element of code 99401, “Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15 minutes,” is met when the physician spends at least eight minutes of face-to-face time counseling the patient.
Can an office visit and preventive visit be billed together?
CPT states that if a new or existing problem is assessed and managed at the time of the preventive visit, the physician should also bill a problem-oriented visit (an office visit) on the day of the preventive care.
Can you bill an office visit and hospital visit on the same day?
CPT Codes 99221-99223, 99231-99236, 99238 & 99239
MACs pay both visits if you see a patient in the office on 1 day, and they're admitted to the hospital as an inpatient or get observation care on the next day.
Medical Billing & Coding Pro Tip 2: 992x4 Codes will Usually Pay More Than 920x4!
Can you bill a procedure and office visit together?
Sometimes yes, sometimes no. The decision to perform a minor procedure is included in the payment for the procedure, unless a significant and separate E/M is needed, performed and documented. Watch this short video to learn more.
What is the 77 modifier in medical billing?
CPT Modifier 77 'Repeat procedure by another physician': A physician may need to indicate that he or she repeated a service performed by another physician on the same day.
Can you bill 99213 and 99455 together?
Can I code 99455 for a work-related or medical disability evaluation as well as a regular office-visit code (such as 99213) for the same encounter, if it's appropriate? Yes. Code 99455 is one of three used to report evaluations required for life or disability insurance certificates.
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 and office visit for a telehealth?
E-Consults: A health care provider at the distant site may bill for an e-consult with the CPT Codes listed in the Medi-Cal Telehealth Provider Manual when the benefits or services delivered meet the procedural definition and components of the CPT code for e-consults as defined by the AMA as well as any requirements ...
Can you bill 99401 with modifier 25?
It is also possible to bill 99401 with modifier 25 on the same day as an EM code, if COVID vaccine counseling is provided. OIC Answer: Yes, a vaccine counseling code can be billed on the same day as a vaccine administration code is billed.
What is E&M code 99401?
Preventive counseling, individual, 15 minutes
This code is applied when healthcare providers engage in counseling or risk reduction interventions for individuals in a group setting, emphasizing the preventive nature of the services provided.
How do I bill for a nurse visit?
There are times when it is appropriate to report for a nurse visit using CPT code 99211. The Incident-to rule applies when reporting this code, and services provided must be documented as medically necessary services, including the clinical history, clinical exam, making a clinical decision, and physician supervision.
What are the guidelines for billing 99401?
At an encounter separate from a preventive medicine visit, the provider offers counseling related to subjects appropriate for the patient's age, family history, and areas of concern. The subjects covered relate to prevention and risk factor reduction. Use this code for a session lasting roughly 15 minutes.
Can you bill a 99214 for telephone visit?
For the duration of the public health emergency, CMS and some private payers are allowing audio-only telephone calls to be billed in the same way as in-person visits and these visits will be paid in equivalent amounts as E&M codes 99212-99214.
What is a 25 modifier used for in medical billing?
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 you bill 99401 with 99214?
Reimbursement for 99401 is typically on the order of $30-40. While not a princely sum, this is typically a service done in addition to pharmacotherapy management. Apply a 25 modifier, denoting a separate service on the same visit, and this will earn an extra $35 on your standard 99214 reimbursement.
Can you bill TCM and E&M same day?
A8: A physician or NPP may report both the discharge code and appropriate TCM code if he or she provided both services. However, Medicare will prohibit billing a discharge day management service on the same day that a required E/M visit is furnished under the CPT TCM codes for the same patient.
Can you bill for two CPT codes at the same time?
There is a myth that exists that you can't bill 2 CPT codes during the same 15-minute time period. Well, that myth is only partially true. It is possible to bill 2 CPT codes during the same 15-minute time period.
What are the rules for CPT code 99213?
What is CPT code 99213 used for? CPT code 99213 is used for an established patient office or other outpatient visit that requires a medically appropriate history and/or examination and low level of medical decision-making along with 20 minutes of encounter time.
Does 99213 need a modifier?
If the circumstance calls for a Level 3 established patient visit (CPT code 99213) to be billed with psychological testing (such as CPT code 96101), modifier 59 would be appended to the testing code.
Can 99213 be billed for telehealth?
These services should be billed using standard E/M codes. For example, a level 3 office visit provided to an established patient via telehealth should be billed using code 99213.
What is a 79 modifier used for?
Modifier 79 is used to indicate an unrelated procedure performed by the same physician during the postoperative period of the original surgery. When the procedure is related to the original surgery or is a staged (anticipated) surgery, it falls under the global period and should not use Modifier 79.
Will Medicare pay for two visits on the same day?
The para states that as for all other E/M services except where expressly noted, the Medicare Administrative Contractors (MACs) may not pay two E/M office visits billed by a physician (or physician of the same specialty from the same group practice) for the same beneficiary on the same day unless the physician ...
What is a 73 modifier used for?
Modifier -73 is used by the facility to indicate that a surgical or diagnostic procedure requiring anesthesia was terminated due to extenuating circumstances or to circumstances that threatened the well being of the patient after the patient had been prepared for the procedure (including procedural pre-medication when ...