What ages are 99395?
Asked by: Ernesto Durgan Sr. | Last update: August 6, 2025Score: 4.3/5 (42 votes)
What is the age range for 99395?
99393 – established patient; late childhood (age 5 through 11 years) 99395 – established patient, adult 18-39 years.
What is the difference between 99396 and 99395?
99395: preventive care for established patients ages 18 through 39. 99396: preventive care for established patients ages 40 through 64.
What is the CPT code for 18 year old well visit?
For children ages 12 to 17 (adolescent), use CPT code 99384. For children age 18 (adolescent), use CPT code 99385. For established patients making a well baby/well child care visits: • For infants under age 1, use CPT code 99391.
What is 99395 in medical billing?
CPT code 99395 designates a comprehensive preventive medicine evaluation and management service for established patients, emphasizing the in-depth assessment involved in preventive care.
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Can 99395 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 criteria for 99358?
The prolonged service must occur on a different day (before or after) than the related face-to-face encounter. Prolonged services of less than 30 minutes are not coded. Use 99358 when at least 30 minutes beyond the typical time is met (30 – 74 minutes). Use 99359 for each additional 30 minutes of prolonged time.
What is the CPT code for well exam 12 17 years old?
CPT Code 99394: Adolescents (ages 12–17 years)
Addresses physical and emotional changes during puberty. Includes discussions about mental health, risky behaviors, and lifestyle habits. Vaccinations, such as HPV and meningococcal boosters, are updated as needed.
What is the CPT code for wellness exam by age?
Adults (Ages 40-64)
Between the ages of 40 and 64, preventive services expand to include screenings and assessments aligned with age-specific risks. CPT codes 99386 (new patients) and 99396 (established patients) are appropriate for this group.
What is the age limit for CPT code 90715?
90714 Tetanus and diphtheria toxoids (Td) adsorbed, preservative free, when administered to individuals 7 years or older, for intramuscular use 90715 Tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap), when administered to individuals 7 years or older, for intramuscular use 90716 Varicella virus vaccine ...
What modifier is used for 99395?
Wiki - 99395 with modifier 25 | Medical Billing and Coding Forum - AAPC.
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.
What is the CPT code for a well visit?
AWV Coding. 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.
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 the age limit for annual wellness visit?
The visit must be at least 11 full months after your previous year's visit. Do I need to be 65 or older to have an Annual Wellness Visit? You do not need to be 65 years of age or older to qualify for an Annual Wellness Visit, as long as you've been on Medicare Part B for at least one year.
What is CPT code 99396 for well woman exam?
The second most commonly used CPT code was 99396, a preventative visit for an established patient between 40 and 60 years of age. The third most common preventive medicine CPT code was 99409, a 3- to 10-minute intermediate counseling session on smoking and tobacco use cessation.
What is the age limit 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.
What is CPT code 99395 used for?
99395 – Preventive Service, est patient 18-39 years (Primary DX – Z00. 0 - annual exam)
What is a wellness exam for seniors?
The Medicare annual wellness visit, covered by Medicare, allows your health-care provider to conduct a health risk assessment and propose screenings and prevention strategies. As well, your provider will make sure all your immunizations, cancer screenings and other screenings are discussed and scheduled.
What is the CPT code for a 16 year old?
CPT Code 99384 Preventive visit, established patient, adolescent (age 12 through 17 years) | Upvio.
What is the CPT code for adult exam?
An initial Annual Wellness Visit code is documented using G0438, subsequent Annual Wellness Visits are documented using code G0439.
What age is CPT code 99397?
The provider performs an established well–patient visit for a patient who is 65 years or older.
Can a CPT code 99358 be billed alone?
Report CPT code 99358. Coding tip: Because the pediatrician performed more than 30 minutes of work on a single calendar date, non-direct prolonged services can be reported. Since 99358 is a stand-alone code, it can be reported on Friday before the initial encounter on Monday.
Will Medicare pay for 99358?
Non-face-to-face prolonged care codes 99358 and 99359 are still active codes, but Medicare does not recognize them. Changes to code 99417 descriptor: CPT removed the words “beyond the minimum required time” from the descriptor for +99417.
What is the difference between G2212 and 99358?
HCPCS code G2212 is to be used for billing the MPFS instead of CPT code 99358, 99359 or 99417, with the following descriptor: “Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the ...