Is 99396 an annual wellness visit?
Asked by: Susanna Walker | Last update: September 26, 2025Score: 4.6/5 (29 votes)
What is the CPT code 99396 for an annual wellness visit?
CPT code 99396 signifies a comprehensive preventive medicine evaluation and management service for established patients.
What is considered an annual wellness visit?
Covers certain doctors' services, outpatient care, medical supplies, and preventive services. for longer than 12 months, you can get a yearly “Wellness” visit to develop or update your personalized plan to help prevent disease or disability, based on your current health and risk factors.
Is a wellness visit the same as a preventive visit?
Medicare's Annual Wellness Visits (AWV) are annual preventive visits for patients to create or update a personalized prevention plan. These preventative visits are designed to let the patient explain to their provider how they feel about their health status by filling out a health risk assessment.
What is the difference between 99396 and 99395?
adolescent (age 12 through 17 years) 99395 …18-39 years. 99396 … 40-64 years.
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What age is 99396 for?
The second most commonly used CPT code was 99396, a preventative visit for an established patient between 40 and 60 years of age.
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 not included in a wellness visit?
Your insurance for your annual wellness visit does not cover any discussion, treatment or prescription of medications for chronic illnesses or conditions, such as high blood pressure, high cholesterol or diabetes. In this instance as well, you will be charged a copay and/or a deductible.
Does an AWV have to be 12 months apart?
We cover only 1 IPPE per patient per lifetime and 1 additional AWV every 12 months after the date of the patient's last AWV (or IPPE). Check eligibility to find when a patient is eligible for their next preventive service.
Are annual wellness visits covered by insurance?
Most insurance plans cover your annual wellness exam—no copay required.
Is bloodwork part of a wellness visit?
Does a Wellness Exam Include Blood Work? Yes, a wellness exam can include blood work. However, it's important to note that the specific tests conducted during a wellness exam may vary from person to person.
How often should you visit your physician for a wellness visit?
General adult physical schedule: For ages 19-21, once every 2-3 years. For ages 22-64, once ever 1-3 years. Over 65, once a year.
Can you bill 99213 and 99396 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.
What is an annual wellness visit?
An "annual wellness visit" is an appointment with your doctor or other care provider that focuses on general health, disease prevention and detecting possible risks to your health.
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.
What is the CPT code 99396 for annual wellness visit?
CPT code 99396 refers to a preventive medicine evaluation and management (E/M) service for patients aged 65 years or older. It involves a comprehensive annual wellness visit (AWV), including personalized preventive medicine planning.
Does Medicare require a wellness visit every year?
The short answer is no, you are not required to have a Medicare Wellness Visit. But when else are you able to spend real time with your doctor?
How often do you need a wellness exam?
The American Medical Association advises that adults between the ages of 18 and 40 receive a physical exam once at least every five years and that adults over 40 should visit every one to three years after that.
What is the difference between AWV and annual physical?
An annual physical exam is more extensive than an AWV. It involves a physical exam by a doctor and includes bloodwork and other tests. The annual wellness visit will just include checking routine measurements such as height, weight, and blood pressure.
What is the difference between preventive and wellness visit?
Preventive care is things like getting your yearly check ups, your vaccinations, things like that to keep you from getting sick. And then wellness care would be like, "I'm sick I should go to the doctor now."
What falls under wellness category?
Wellness comprises of eight mutually co-dependence dimensions: emotional, physical, occupational, social, spiritual, intellectual, environmental, and financial. If any one of these dimensions is neglected over time, it will adversely affect one's health, well-being, and quality of life.
What documentation is required for 99396?
Accurate and detailed documentation is crucial for proper billing of CPT Code 99396. Primary care providers must ensure that all components of the visit, including the medical history, physical examination findings, counseling services provided, and screenings performed, are clearly and accurately documented.
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.
Is an annual wellness exam the same as a Pap?
A gynecological (GYN) wellness exam is performed by a medical provider with specialized training in gynecology, the medical specialty for women's reproductive health. The benefits of a yearly visit extend well beyond a Pap smear.