What is CPT code 99385 preventive visit?
Asked by: Dr. Kaylee Quigley | Last update: July 30, 2025Score: 4.7/5 (61 votes)
What is the CPT code for preventive visit?
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 99385 and 99395?
99385: preventive care for new patients ages 18 through 39. 99386: preventive care for new patients ages 40 through 64. 99395: preventive care for established patients ages 18 through 39. 99396: preventive care for established patients ages 40 through 64.
Is CPT 99385 covered by Medicare?
Medicare will pay on the Initial or Periodic comprehensive preventive medicine evaluations using either the 99385-99397 codes or the G0438 or G0439 codes as long as the primary diagnosis code is V70.
What is the age limit for CPT code 99385?
99385 …18-39 years.
2023 Annual Wellness Visits (AWV) CPT Codes, Billing, and Reimbursements
What is CPT code 99385 used for?
Within the landscape of preventive medicine services, 99385 holds significance as a code representing a comprehensive preventive medicine evaluation and management service for new patients.
What is the difference between preventive visit and office visit?
The purpose of a preventive visit is to review your overall health, identify risks and find out how to stay healthy. Your plan covers 100% of a preventive visit when you see a doctor in your plan network. * The purpose of an office visit is to discuss or get treated for a specific health concern or condition.
Can you bill a preventive visit to Medicare?
Requirements and components for G0402 include: Billable for the IPPE only. Patients are only eligible if they are in their first 12 months of Medicare Part B coverage. Medicare pays for one IPPE per beneficiary, per lifetime.
What labs are considered preventive?
- 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.
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 modifier can be used with 99385?
Beginning with claims processed on or after February 1, 2023, Empire BlueCross BlueShield HealthPlus will implement additional steps to review claims for evaluation and management (E/M) services submitted by professional providers when a preventive service (CPT® codes 99385-99387 or 99395-99397) is billed with a ...
Is preventive care the same as annual wellness visit?
You schedule preventive visits which are annual physicals, well child exams and wellness exams to help prevent or detect any health concerns. This is also known as your annual wellness exam or annual health maintenance exam.
What is the CPT code for an annual wellness 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. It is important to remember that code G0438 is for the first AWV only.
What are the three types of Medicare wellness visits?
- Initial Preventive Physical Exam (IPPE)
- Initial Annual Wellness Visit (AWV)
- Subsequent AWVs.
Can a dermatologist bill for preventive care?
It would NOT be appropriate for a dermatologist to report a code from the Preventive Medicine range (CPT 99381-99397) because a dermatologist is a specialist.
Which is typically included in a preventive care visit?
A preventive visit typically covers a physical exam as well as a check in on your mental health to help your doctor identify any medical issues that could become a major concern, either physical or mental.
Is an A1C test considered preventive?
The A1C test is diagnostic. Whether your visit is preventive or diagnostic can have a big affect on how much you pay.
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.
What is CPT code 99385?
99385 - CPT® Code in category: Initial comprehensive preventive medicine evaluation and management of... CPT Code information is available to subscribers and includes the CPT code number, short description, long description, guidelines and more.
What is the new CPT code for preventive visit?
CPT code 99397 designates a comprehensive preventive medicine evaluation and management service for established patients, emphasizing the in-depth assessment involved in preventive care.
Does Medicare pay for preventive visits?
Medicare pays for many preventive services to keep you healthy.
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.
Why didn't my insurance 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.
Is a diagnostic mammogram considered preventive care?
A mammogram, for example, is offered as a preventive screening. But it can also be used as a diagnostic tool if there is a reason (such as pain or a detected lump) to believe breast cancer may be present.