What does preventive mean in medical billing?
Asked by: Piper Friesen | Last update: November 15, 2025Score: 4.5/5 (36 votes)
What are preventive services in medical billing?
Routine health care that includes screenings, check-ups, and patient counseling to prevent illnesses, disease, or other health problems.
What are examples of preventive services?
- 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 preventive in medical terms?
Prophylaxis — or preventive care — is all the stuff you do to keep from getting sick. It includes things like vaccinations, health screenings and annual checkups. Prophylaxis can also help healthcare providers detect diseases and conditions in their earliest stages — before they get worse.
What's the difference between diagnostic and preventive?
Examples of preventive care include annual check-ups, immunizations and certain screenings. Unlike preventive care, diagnostic care is care you receive when your doctor is testing or treating you for a symptom or health issue you already have, like an existing condition, illness or injury.
Understanding Preventative Medicine Codes
Why did I get a bill for a preventive care visit?
If you schedule a preventive care visit and ask your doctor about a specific health concern or condition, your clinic may code and bill the appointment as an office visit. If you want to know about costs, ask your doctor for an estimate of fees before you visit.
Is A1C considered preventive?
The A1C test is diagnostic. Whether your visit is preventive or diagnostic can have a big affect on how much you pay.
Is preventive care covered by insurance?
Most health plans must cover a set of preventive services — like shots and screening tests — at no cost to you. This includes plans available through the Health Insurance Marketplace ®. These services are free only when delivered by a doctor or other provider in your plan's network.
What do you mean by preventive?
: devoted to or concerned with prevention : precautionary. preventive steps against soil erosion. : such as. a. : designed or serving to prevent the occurrence of disease.
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.
Does Medicare cover preventive care?
Visit PrEP for HIV & Related Preventive Services. Medicare covers many preventive services to keep your patients healthy. Preventive services can help find health problems early, when treatment works best, and can help keep your patients from getting certain diseases.
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.
Is a 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.
What is preventive services examples?
Preventive services include exams, shots, lab tests, and screenings. They also include programs for health monitoring, and counseling and education to help you take care of your own health.
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.
What is the difference between preventive and diagnostic billing?
HOW CAN I PAY TWO DIFFERENT AMOUNTS FOR THE SAME PROCEDURE? Preventive care, or routine care, is typically covered at 100 percent. Diagnostic tests or screenings performed for treating or diagnosing a medical condition are covered according to your specific insurance plan.
What is preventive in medical?
Preventive medicine aims to prevent disease, disability, and death by taking a proactive approach to medicine. Preventive medicine physicians provide advice, suggestions, and recommendations to help patients maintain or improve their health and wellness.
What is the best example of preventive care?
- Screen for diseases, such as high blood pressure, diabetes, and cancer.
- Look for future disease risks, such as high cholesterol and obesity.
- Discuss alcohol use and safe drinking and tips on how to quit smoking.
- Encourage a healthy lifestyle, such as healthy eating and exercise.
- Update vaccinations.
What is preventive action in simple words?
Preventive action is a system to eliminate any cause(s) that would create a potential hazard or undesirable situation. Changes can be made or implemented to address an issue, hazard, or weakness in a system.
What does preventive care 100% mean?
With health reform, many people are now aware that preventive care is covered at 100 percent–meaning there is no out-of-pocket cost to the patient.
What are two types of preventive care?
Services like screenings, dental check-ups, and vaccinations are key to keeping people of all ages healthy. But for a variety of reasons, many people don't get the preventive care they need.
Is preventative care worth it?
Clinical preventive services (CPS) play an integral role in protecting and promoting individual health and the health of communities. Such services can help people recognize health problems early, when treatment often is most effective. CPS can also help prevent certain diseases altogether.
What A1C is no longer diabetic?
The number represents the portion of hemoglobin proteins that are glycated, or holding glucose. The higher the percentage, the higher your blood sugar levels have been over the last few months. For diagnosing purposes, an A1C level of: Less than 5.7% means you don't have diabetes.
Can drinking water lower A1C?
Summary. Drinking water won't lower your blood sugar levels, but staying hydrated can help you manage them if you have diabetes. Regularly drinking enough water is healthy, and research has linked it to a reduced risk of high blood sugar and diabetes.
What is an alarming A1C?
In those without diabetes, A1C levels should stay below 5.7%. Dangerous levels of A1C are 9.05% and higher. An A1C above 9% increases the risk of long-term diabetes complications like blindness, nerve damage, and kidney failure. 2 Under 7% is considered good diabetes control.