What is CPT code 99395 billing guidelines?
Asked by: Miss Aubree Koelpin | Last update: May 22, 2025Score: 5/5 (17 votes)
What is the billing code for annual physical exam?
At ChartSpan, we provide eligibility checks for G0438 and G0439 — the core codes for Annual Wellness Visits. However, some AWVs may involve additional codes depending on a patient's needs.
What is the difference between 99396 and 99395?
adolescent (age 12 through 17 years) 99395 …18-39 years. 99396 … 40-64 years.
What age is CPT code 99395?
99395 – Preventive Service, est patient 18-39 years (Primary DX – Z00. 0 - annual exam)
How to bill a 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.
CPT Code 99490 Billing Guidelines
How do I bill for annual gyn exam?
- Report appropriate Preventive E/M (9938X or 9939X)
- Report Pelvic exam Add-on (99459)
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 are the guidelines for CPT 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 covered in a preventive visit?
Counseling on such topics as quitting smoking, losing weight, eating healthfully, treating depression, and reducing alcohol use. Regular well-baby and well-child visits. Routine vaccinations against diseases such as measles, polio, or meningitis. Counseling, screening, and vaccines to ensure healthy pregnancies.
What is 99395 for Medicare?
99395 ‑ 99397 V70. 0 Periodic comprehensive preventive medicine reevaluation and management of an individual (non‑covered service under Medicare Part B)
What modifier is used for 99395?
Wiki - 99395 with modifier 25 | Medical Billing and Coding Forum - AAPC.
What is the difference between annual wellness visit and preventive visit?
The prevention plan includes a screening schedule for preventive services to help the patient maintain their health and prevent potential illnesses. An annual physical includes a wellness exam and a full physical exam including blood work, lab tests and vaccinations.
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.
Is a physical exam required for billing?
Only a "medically appropriate history and/or examination" is required for all office/outpatient E/M codes. The number of body systems/areas reviewed and examined need only be performed and documented when medically necessary and clinically appropriate.
What is the procedure code for annual gyn exam?
NON-MEDICARE PAYERS
Preventive medicine codes (99381–99387 and 99391–99397) are used to report annual well-woman examinations and determined by the age of the patient and whether she is considered a new or established patient to the physician or practice.
What is not included in a wellness visit?
Your insurance for your annual wellness visit does not cover any discussion, treatment or prescription of medications for chronic illnesses or conditions, such as high blood pressure, high cholesterol or diabetes. In this instance as well, you will be charged a copay and/or a deductible.
Are annual physicals covered by insurance?
Most insurers cover an annual physical exam done once a year without copay. However, the coverage may exclude associated costs such as lab analysis. In other instances, the insurer may require you to pay a portion of specific recommended tests and services.
Is a dermatologist visit considered preventive care?
Answer: The visit to the dermatologist is not considered preventive care.
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;
Can you bill an office visit with a preventive visit?
Physicians are not prohibited from coding and billing for both preventive and problem-focused E/M services when they are performed during the same appointment.
What are the new guidelines for Pap?
Follow these Guidelines:
If you are 21 to 29— Have a Pap test alone every 3 years. HPV testing alone can be considered for women who are 25 to 29, but Pap tests are preferred. If you are 30 to 65—You can choose one of three options: Have a Pap test and an HPV test (co-testing) every 5 years.
What is the procedure 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. 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 is CPT code 99395 used for?
CPT code 99395 designates a comprehensive preventive medicine evaluation and management service for established patients, emphasizing the in-depth assessment involved in preventive care.
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.
Can a patient see two doctors on the same day?
Patients often schedule two medical appointments on the same day with physicians of different specialties. It's convenient for them. It saves travel time. It may mean the patient or a family member only needs to take one day off work.