Is 99213 a preventive code?
Asked by: Mabelle Huel | Last update: August 23, 2025Score: 4.3/5 (61 votes)
What type of code is 99213?
CPT® code 99213: Established patient office or other outpatient visit, 20-29 minutes.
What CPT codes are considered preventive?
Preventive visit codes 99381-99397 include “counseling/anticipatory guidance/risk factor reduction interventions,” according to CPT. However, when such counseling is provided as part of a separate problem-oriented encounter, it may be billed using preventive medicine codes 99401-99409.
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.
Does Medicare pay for 99213?
Medicare will pay a physician for an AWV service and a medically necessary service, e.g. a mid-level established office visit, Current Procedural Terminology (CPT) code 99213, furnished during a single beneficiary encounter.
What is a level 3 or 2 office / outpatient visit in medical coding? 99213 & 99203 explained
Is CPT code 99213 preventive?
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.
What is considered a preventive doctor visit?
A medical preventive visit is a yearly doctor's appointment intended to prevent illnesses and detect health concerns early, before symptoms are noticeable. Preventive visits could be an annual physical, well-child exam, Medicare wellness exam or welcome to Medicare visit.
Can I bill 99396 and 99213 together?
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.
Does Medicare pay for preventive visits?
Medicare pays for many preventive services to keep you healthy.
What is not covered under preventive care?
What's not considered preventive care? There are times when certain tests and screenings aren't considered preventive care. Things like diagnostic care, bloodwork and sexually transmitted infection (STI) testing may or may not be considered preventive.
What is the CPT code for Medicare preventive visit?
G0402: This code applies to the Welcome to Medicare visit — also referred to as an Initial Preventive Physical Exam (IPPE).
What is the CPT code 99395 and 99213?
99395 – Preventive Service, est patient 18-39 years (Primary DX – Z00. 0 - annual exam) 99213 – Office Visit – Low level (Primary DX – E11. 9 – diabetes without complications)
What is an example of a 99213 visit?
An example of a 99203 or 99213 is a sinus infection treated with an antibiotic. Although the prescription makes the risk component moderate, the one acute uncomplicated illness is a low-complexity problem, and there are no data points.
Can you bill 99213 for telehealth?
During the COVID-19 public health emergency, many physiatrists are performing standard office visits via 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 the CPT code for office visit?
Office or Other Outpatient Services CPT® Code range 99202- 99215. The Current Procedural Terminology (CPT) code range for Office or Other Outpatient Services 99202-99215 is a medical code set maintained by the American Medical Association.
When should 99213 be billed?
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.
Why am I being charged for preventive care?
Although you don't pay cost-sharing charges when you receive preventive care, the cost of those services is wrapped into the cost of your health insurance. Thus, whether or not you choose to get the recommended preventive care, you're paying for it through the cost of your health insurance premiums anyway.
What is the E&M code for preventive visit?
Codes 99381-99397 are used to report the preventive evaluation and management (E/M) of infants, children, adolescents, and adults. The extent and focus of the services will largely depend on the age of the patient.
Why did my insurance not cover my doctor visit?
In some cases, the service simply isn't covered by the plan. In other cases, necessary prior authorization wasn't obtained, the provider wasn't in-network, or the claim was coded incorrectly.
What is the difference between preventive and annual visit?
The prevention plan includes a screening schedule for preventive services to help the patient maintain their health and prevent potential illnesses. An annual physical includes a wellness exam and a full physical exam including blood work, lab tests and vaccinations.
What type of service is not considered to be a preventive medical service?
Alternative therapies: Services such as chiropractic, massage, acupuncture, and other alternative health services are not considered preventive care.
Can 99213 and 99396 be billed together?
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.
Is 99213 covered by Medicare?
For example, a 67-year-old established patient presents for a covered service, such as an office visit for a chronic illness (e.g., 99213). At the same encounter, the patient chooses to receive a preventive medicine examination (e.g., 99397), which is a non-covered service under Medicare.
How much is an office visit vs urgent care?
Urgent care centers typically charge more than a visit to your primary care physician but are still far more affordable than the emergency room. On average, an urgent care visit costs $150 to $200, while a primary care appointment is $75 to $150.