Can you bill 99213 and 99396 together?
Asked by: Miss Mona Zulauf | Last update: September 16, 2025Score: 4.9/5 (44 votes)
Can CPT 99396 be billed with CPT 99213?
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.
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 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 99213 and 99395 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
Can you add modifier 25 to 99396?
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 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.
What are the requirements for 99396?
The components of CPT Code 99396 include obtaining a detailed medical history, performing a comprehensive physical examination, providing counseling services, conducting screenings for various diseases and conditions, and assessing the patient's risk factors for developing certain conditions.
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.
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.
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 99204 and 99386 be billed together?
Medicare doesn't pay for 9938* or 9939* codes. A preventative and sick visit can be billed together if the documentation supports it but if it is a new patient you cant bill a 99386 and a 99204. One code has to be a new patient code and the other would be a established patient.
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.
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.
Can I use modifier 25 on a preventive visit?
Modifier 25 should be appended to the office or other outpatient visit code to indicate that a significant, separately identifiable E/M service was provided on the same date as the preventive medicine E/M service, and the appropriate preventive medicine E/M service is additionally reported without a modifier.
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.
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.
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 I bill an office visit with an AWV?
When you provide an AWV and a significant, separately identifiable, medically necessary evaluation and management (E/M) service, we may pay for the additional service. Report the additional CPT code (99202–99205, 99211–99215) with modifier 25.
What is CPT code 99386 billing guidelines?
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.
Can 99396 be billed as 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.
What is the CPT for yearly wellness exam?
The CPT codes for Annual Wellness Visits are G0438 for the initial visit and G0439 for subsequent visits. These codes are used to bill Medicare for comprehensive wellness assessments and personalized prevention plans.
How to bill 99396?
You document both the problem-oriented and the preventive components of the encounter in detail. You should submit 99396, “Periodic comprehensive preventive medicine ..., established patient; 40-64 years” and ICD-9 code V70.
What level of visit is 99213?
What is CPT Code 99213? Level 3 code in the Evaluation and Management (E/M) category. CPT 99213 specifically describes a moderate-complexity office or outpatient visit.