Can you bill 99395 and 99213 together?
Asked by: Dr. Freida Fritsch Sr. | Last update: August 21, 2025Score: 5/5 (16 votes)
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 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.
Can modifier 25 be used with preventive services?
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.
What is the billing guideline for 99395?
The 99395 CPT code is used to describe a preventive (well-patient) outpatient office visit for an established patient between the ages of 18 and 39.
Medical Coding 99213 vs 99214 - MDM Medical Decision Making Explained
Can you bill 99395 with 99213?
can be used 99213 with 99395 at the same visit? Absolutely!
How do I bill for annual gyn exam?
- Report appropriate Preventive E/M (9938X or 9939X)
- Report Pelvic exam Add-on (99459)
Can modifier 25 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 CPT modifier for preventive services?
Current Procedural Terminology (CPT) modifier 33 can be used when billing for ACA-designated preventive services with a commercial payer. The addition of modifier 33 communicates to a commercial payer that a given service was provided as an ACA preventive service.
When not to use modifier 25?
Modifier 25 should not be used when: ❌ The sole purpose of the encounter is for the procedure (e.g., lesion removal), and there is no documented medical necessity for a separate E/M service.
What is the modifier for office visit and procedure same day?
Modifier 25 Description
The provider may need to indicate that on the day of a procedure was performed; the patient's condition required a significant, separately identifiable E&M service above and beyond the usual preoperative and post- operative care associated with the procedure.
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.
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.
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 99396 and 99215 together?
When billing 99215 with 99396, do both codes need modifier 25? Yes, We need to append modifier 25 to 99215. But do remember that the service should be separately identifiable E&M service was provided by the same physician on the same day as the preventive medicine service.
Can you bill a preventive visit with an office visit?
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.
What is CPT code 99395 billing guidelines?
CPT code 99395 designates a comprehensive preventive medicine evaluation and management service for established patients, emphasizing the in-depth assessment involved in preventive care.
Can I use modifier 25 on a preventive visit?
This code can help you to get reimbursed for the extra work you do at certain visits. Many times a patient's “Oh, by the way …” comment turns an encounter that was scheduled as a preventive medicine visit or a minor office surgery into something more.
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.
Can you bill an AWV and E&M together?
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 modifier 59 for 99213?
If the circumstance calls for a Level 3 established patient visit (CPT code 99213) to be billed with a demonstration of home monitoring of a patient's international normalized ratio (e.g., HCPCS code G0248), modifier 59 would be appended to the demonstration code.
How to bill a Pap smear with an office visit?
Summary of pap smear billing guidelines
If a clinician is reporting CPT® preventive medicine services, and also performing a screening pap smear report a code in 99381-99397 series and Q0091. Use G0101 and Q0091 for Medicare patients receiving a screening pelvic and breast exam and also a screening pap smear.
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.
What is the CPT code for preventive gynecological exam?
Preventive medicine codes (99381–99387 and 99391–99397) are used to report annual well-woman examinations and determined by the age of the patient and whether she is considered a new or established patient to the physician or practice.