What is CPT code 99395 used for?
Asked by: Frieda Volkman | Last update: September 15, 2025Score: 4.5/5 (17 votes)
When to use 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 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;
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 is the CPT code for gyn physical exam?
CPT® codes 99381–99397 include an age and gender-appropriate history and physical exam for both new and established patients. Note that G0101, pelvic and clinical breast exam, would be considered double-billing on the day of a CPT preventive visit.
What is a CPT Code in Medical Billing?
What is the difference between screening and diagnostic Pap smears?
Screening Pap tests are routine tests collected and evaluated for preventive health visits. Diagnostic Pap tests are performed after a patient has been diagnosed with a cervical abnormality and is being actively followed and treated.
What is the CPT code for Medicare women's wellness exam?
For Medicare Advantage, the CPT codes for well woman exams include: G0403 for the Initial Preventive Physical Exam (IPPE). G0438 for the first Annual Wellness Visit (AWV). G0439 for subsequent AWVs.
What is the difference between a physical and an annual wellness visit?
While a physical includes a full examination and a wellness evaluation, an Annual Wellness Visits focuses solely on a patient's answers to a health risk assessment. It does not typically include any lab work or tests requiring physical contact.
What is the CPT code for a physical exam?
CPT® Code 2040F - Physical Examination - Codify by AAPC.
What diagnosis code to use for an annual wellness visit?
You can only bill G0438 or G0439 once in a 12-month period. G0438 is for the first AWV, and G0439 is for subsequent AWVs.
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.
What does Medicare pay for an annual wellness visit?
If you qualify, Original Medicare covers the Annual Wellness Visit at 100% of the Medicare-approved amount when you receive the service from a participating provider. This means you pay nothing (no deductible or coinsurance).
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.
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 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.
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.
What age is CPT code 99395?
99395 – Preventive Service, est patient 18-39 years (Primary DX – Z00. 0 - annual exam)
Can you bill an office visit with an annual wellness visit?
CPT states that if a new or existing problem is assessed and managed at the time of the preventive visit, the physician should also bill a problem-oriented visit (an office visit) on the day of the preventive care. But insignificant problems that do not require extra work should not be billed as office visits.
Is an annual physical exam 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 bloodwork part of a wellness visit?
Does a Wellness Exam Include Blood Work? Yes, a wellness exam can include blood work. However, it's important to note that the specific tests conducted during a wellness exam may vary from person to person.
How often will Medicare pay for a physical exam?
While Medicare does not cover annual physical exams, it does cover a single "initial preventive physical examination," or IPPE, followed by exams called "annual wellness visits," or AWVs.
How to bill an annual gyn exam?
- Report appropriate Preventive E/M (9938X or 9939X)
- Report Pelvic exam Add-on (99459)
How often does Medicare pay for a well woman exam?
Medicare covers these screening tests once every 24 months in most cases. If you're at high risk for cervical or vaginal cancer, or if you're of child-bearing age and had an abnormal Pap test in the past 36 months, Medicare covers these screening tests once every 12 months.
What is the CPT code for annual wellness check?
AWV CPT Codes to Know: G0402, G0438, G0439
There are three types of wellness visits: Initial Preventive Physical Examination (IPPE), an Initial Annual Wellness Visit, and the Subsequent Annual Wellness Visit. Each entails a different billing code as well as specific qualifiers for each program.