Is CPT code 99459 considered preventive care?
Asked by: Mazie Sanford | Last update: May 9, 2025Score: 4.5/5 (51 votes)
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.
Does CPT code 99459 require a chaperone?
While chaperone time may be included as part of the staff time, the CPT code does not require the presence of a chaperone. Furthermore, reimbursement for this code is Payer specific, and therefore, we recommend checking with your individual Payers.
What is CPT code 99459 fee schedule?
CPT® code 99459 (Pelvic Exam) captures the 4 minutes of clinical staff time associated with chaperoning a pelvic exam.” The national, non-facility payment rate (i.e., not adjusted for locality) is $22.64.
Is colonoscopy considered preventive care in United healthcare?
A: Yes, in this situation, the colonoscopy would be considered under the preventive care services benefit when billed in accordance with the coding in the Colorectal Cancer Screening row listed in this policy.
Establishing Care vs. Preventative Care Coding
Can colonoscopy be billed as preventative?
If a procedure is billed as a screening, colonoscopy benefits will be applied as preventive based on the intent of the test and not on the findings.
Is a colonoscopy considered routine preventive care?
Colonoscopies are either diagnostic or preventive. The difference between the two is sometimes hard to distinguish, but there is big difference on how insurance companies cover either procedure.
How do I bill my CPT 99459?
The code is valued at 0.68 practice expense RVUs, capturing four minutes of clinical staff time when chaperoning a pelvic exam and also the expense of the supply pack, including a speculum. As an “add-on” code, this is listed separately on a separate claim line, in addition to the code for E/M service.
How to bill 99495?
Both CPT codes, 99495 and 99496, account for medical decision-making. The differential is within the complexity, moderate or high, of medical decision-making required. CPT code 99495: TCM services with moderate medical decision complexity and includes a face-to-face office visit within fourteen (14) days of discharge.
What is fee schedule in medical terminology?
A fee schedule is a predetermined list of fees or charges that healthcare providers, such as hospitals, physicians, and other healthcare facilities, establish for their services. It serves as a guideline for determining the cost of medical procedures, treatments, and services provided to patients.
What DX code for 99459?
Pelvic Examination add-on code 99459: Preventive care services benefits may apply to 99459 when the related evaluation and management (office visit)code is applied to the preventive cares ervices benefit. CPT code 99459 may not be payable in all circumstances due to other policies or guidelines.
What is the CPT code for transitional care visit?
The two CPT codes used to report TCM services are: CPT code 99495 – moderate medical complexity requiring a face-to-face visit within 14 days of discharge. CPT code 99496 – high medical complexity requiring a face-to-face visit within seven days of discharge.
Can 99459 be billed with 99024?
If your physician documents pelvic exams appropriately, you can report +99459 alongside one of the following evaluation and management (E/M) codes: Office or other outpatient visit for a new patient: 99202-99205. Office or other outpatient visit for an established patient: 99212-99215. Consultation codes: 99242-99245.
What counts as preventive care?
- Blood pressure, diabetes, and cholesterol tests.
- Many cancer screenings, including mammograms and colonoscopies.
- Counseling on such topics as quitting smoking, losing weight, eating healthfully, treating depression, and reducing alcohol use.
- Regular well-baby and well-child visits.
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 does not preventive include?
Examples of non-preventive care include: Diagnostic tests and screenings: These are not routine tests and screenings. For example, if your radiologist finds something on your mammogram and wants another, it's considered a diagnostic mammogram and will typically not be covered as preventive care.
Is 99495 covered by commercial insurance?
There are two CPT codes for TCM: 99495 and 99496. These are active CPT codes, covered by Medicare and most commercial insurances. A member of your staff can look up coverage by payer. Most payers have this information on their websites.
What qualifies as transition of care?
Transition of Care – The movement of a patient from one setting of care (hospital, ambulatory primary care practice, ambulatory specialty care practice, long-term care, home health, rehabilitation facility) to another.
Can 99495 be billed as telehealth?
Don't report the TCM face-to-face visit separately. You can provide CPT codes 99495 and 99496 through telehealth.
How do you bill for nebulizer treatments?
You should submit the appropriate evaluation and management (E/M) office visit code, the code for the nebulizer treatment (94640, “Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes (e.g., with an aerosol generator, nebulizer, metered dose ...
How do I bill my CPT 99359?
You need to spend at least 31 minutes of time to bill the first hour (99358) of prolonged time. 99359: You need to spend at least 76 minutes to bill the first hour plus an additional 30 minutes (+99359) of prolonged time.
How to bill Medicare for depression screening?
Annual Depression Screening: HCPCS Code G0444. Medicare covers annual screening for adults for depression in the primary care setting that has staff-assisted depression care supports in place to assure accurate diagnosis, effective treatment and follow-up.
What is the CPT for colonoscopy preventive?
What's the right code to use for screening colonoscopy? For commercial and Medicaid patients, use CPT code 45378 (Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen(s) by brushing or washing, with or without colon decompression [separate procedure]).
Are colonoscopies covered by insurance as preventative care?
Under the Affordable Care Act, you can get certain preventive health care tests done for free. Colonoscopy is one of these tests. It is often free, but there are some cases in which patients must pay part of the cost.
What type of prevention is a colonoscopy?
A colonoscopy is one of several screening tests for colorectal cancer. Talk to your doctor about which test is right for you. Colorectal cancer almost always develops from precancerous polyps (abnormal growths) in the colon or rectum.