What is CPT code 99395 preventive?
Asked by: Verona Dicki V | Last update: June 8, 2025Score: 4.1/5 (22 votes)
What is CPT code 99395 preventive visit?
CPT code 99395 designates a comprehensive preventive medicine evaluation and management service for established patients, emphasizing the in-depth assessment involved in preventive care.
What is the CPT for preventive medicine exam?
The Current Procedural Terminology (CPT) code range for Preventive Medicine Services 99381-99429 is a medical code set maintained by the American Medical Association.
What is the difference between 99396 and 99395?
adolescent (age 12 through 17 years) 99395 …18-39 years. 99396 … 40-64 years.
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;
CPT coding guidelines for Preventive Medicine Services
What is covered under a preventive visit?
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 are the three words to remember for a Medicare wellness exam?
Word recollection (Banana, Sunrise, Chair) Have patient repeat the 3 words, tell them to remember them.
Is a preventive care visit the same as an annual physical?
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 99396 an annual wellness visit?
CPT Code 99396 refers to a preventive medicine evaluation and management (E/M) service for patients aged 65 years or older. It is specifically designed to cover comprehensive annual wellness visits (AWV) that include personalized preventive medicine planning.
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 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 age is 99395?
99393 – established patient; late childhood (age 5 through 11 years) 99395 – established patient, adult 18-39 years.
What is the CPT code for preventive gyn exam?
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 a routine preventive visit?
Routine health care that includes screenings, check-ups, and patient counseling to prevent illnesses, disease, or other health problems.
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.
What is CPT code 99395 billing guidelines?
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.
Are annual wellness visits covered by telehealth?
The patient must virtually consent to using telehealth for a wellness visit and the consent must be documented within the medical record prior to the visit. Visits are covered once per calendar year. Additional E and M codes can be added with no copay for patients with PacificSource Medicare Advantage.
What does CPT stand for?
Current Procedural Terminology (CPT®) codes provide a uniform nomenclature for coding medical procedures and services. Medical CPT codes are critical to streamlining reporting and increasing accuracy and efficiency, as well as for administrative purposes such as claims processing and developing guid.
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.
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.
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.
Can I refuse the Medicare annual wellness visit?
People can refuse a Medicare annual wellness visit, but it is worth considering the potential benefits. Wellness visits can help healthcare professionals detect health issues early on and are an important part of preventive care.
What is not covered in a Medicare annual wellness visit?
Medicare does not cover Annual Wellness Visits if they are used to discuss, plan, or alter treatment for pre-diagnosed chronic illnesses, including high cholesterol, high blood pressure, or arthritis.