What CPT codes are considered preventive?
Asked by: Prof. Melody Stamm | Last update: September 14, 2025Score: 4.3/5 (59 votes)
What are the preventive CPT codes?
Preventive Medicine Services CPT® Code range 99381- 99429. The Current Procedural Terminology (CPT) code range for Preventive Medicine Services 99381-99429 is a medical code set maintained by the American Medical Association.
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.
Is CPT code 99459 considered preventive care?
Pelvic Examination add-on code 99459: Preventive care services benefits may apply to 99459 when the related preventive medicine evaluation and management code is billed as the primary service. CPT code 99459 may not be payable in all circumstances due to other policies or guidelines.
Can you bill 99401 with a preventive visit?
Typically these visits would be considered preventive medicine counseling reported with codes 99401-99404 based on the face-to-face time of the service. Diagnosis code Z71. 84 (“Encounter for health counseling related to travel”) is appropriate for these services.
Ch # 4 | What is Preventive Care Services | What CPT and DX codes are used for Preventive Services
What is the difference between 99401 and 99402?
Code 99401 is described as preventive counseling of approximately 15 minutes and can be reported for 8-22 minutes of counseling by a physician or other qualified health care professional. See 99402-99404 for services of 23 minutes or more.
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.
What is not considered preventive care?
ANSWER: If the physician orders lab work during a preventive care visit, some of the tests may be covered as preventive care, such as a cholesterol screening. However, other blood chemistry panels, such as anemia screening, kidney or liver function, would not be covered as preventive care.
Can I bill 99396 with 99459?
The add-on code, 99459, should only be considered when pelvic exam is performed along with one of the following codes: 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99242, 99243, 99244, 99245, 99383, 99384, 99385, 99386, 99387, 99393, 99394, 99395, 99396, 99397.
Is cpt code 45380 preventive?
Reimbursement Guidelines for CPT Code 45380
Medicare covers screening colonoscopies at 100% without a copay or deductible when performed for preventive purposes and the appropriate CPT and ICD-10-CM codes are submitted.
What is the CPT code for annual wellness visit?
AWV Coding. The CPT codes for Annual Wellness Visits are G0438 for the initial visit and G0439 for subsequent visits.
How do I bill 99214 and 99401 together?
CPT 99401 should be utilized for preventive counseling specifically related to obesity management, while CPT 99214 covers the office visit with moderate medical decision-making. It's crucial to document the preventive counseling separately from the office visit to justify billing both codes.
What is CPT code 99495?
TCM Coding
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 you bill 99396 and 99213 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 CPT code 80050 preventive care?
General Health Panel
CPT code 80050, is composed of metabolic panel, a complete blood count and a TSH level. Several different combinations of CPT codes can combine into 80050.
What is CPT code 99429 used for?
Unlisted E&M Services
CPT codes 99429 (unlisted preventive medicine service) and 99499 (unlisted evaluation and management service) require an approved Treatment Authorization Request (TAR) in order for these codes to be reimbursed.
Can you bill 99213 and 99406 together?
Smoking cessation counseling total time 5 min. Billing: 99213 + 99406 Level 3 office visit and smoking cessation counseling code 3-10 minutes and modifier 25.
What is CPT code 99459 preventive?
The add-on CPT code 99459 Pelvic examination (List separately in addition to code for primary procedure), is a practice expense code, which covers supplies, such as disposable speculum, or the sterilization cost of metal speculum, and 4 minutes of staff time (for example, room setup time, chaperone time).
What qualifies as preventive care?
Routine health care that includes screenings, check-ups, and patient counseling to prevent illnesses, disease, or other health problems.
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.
What are the 3 levels of preventive care?
The three levels of prevention are primary, secondary, and tertiary.
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 needs to be documented for a preventive visit?
- A comprehensive history and physical exam findings;
- A description of the status of chronic, stable problems that are not “significant enough to require additional work,” according to CPT;
- Notes concerning the management of minor problems that do not require additional work;
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.