What is cpt code 99396?
Asked by: Travis Satterfield Jr. | Last update: June 16, 2025Score: 4.6/5 (45 votes)
What does CPT code 99396 include?
The components of CPT Code 99396 include obtaining a detailed medical history, performing a comprehensive physical examination, providing counseling services, conducting screenings for various diseases and conditions, and assessing the patient's risk factors for developing certain conditions.
What is the difference between 99396 and 99395?
adolescent (age 12 through 17 years) 99395 …18-39 years. 99396 … 40-64 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.
Can 99396 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 is a CPT Code in Medical Billing?
Can you bill 99213 and 99396 together?
In this case, you may submit codes for both a preventive service (such as 99396) and a regular office visit (such as 99213) by attaching -25 to the office-visit code.
Can you bill a preventive visit via telehealth?
Yes, billable providers may utilize a telehealth modality to provide FQHC, RHC, or Tribal 638 covered services via synchronous telehealth (audio-visual, two-way communication) to “established” patients. Please see the Provider Manuals provided by telehealth.
How do I bill for an annual gyn exam?
- Report appropriate Preventive E/M (9938X or 9939X)
- Report Pelvic exam Add-on (99459)
What is the CPT code for annual preventive exam?
G0402: This code applies to the Welcome to Medicare visit — also referred to as an Initial Preventive Physical Exam (IPPE).
What is a gyn preventive exam?
Review of preventive services and ordering of appropriate tests, including Pap smear; sexually transmitted disease screening; bone density test; cholesterol test; vaccinations; mammogram; vital signs assessment; and physical examination, including breast and pelvic exam, if needed.
Does Medicare pay for 99396?
As of January 1, 2021, CPT codes 99386 and 99396 will not be paid and will be denied.
What is the difference between a preventive exam and a wellness exam?
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 you bill 99396 and G0439 together?
Don't bill CPT codes 99381-99397 (comprehensive preventive medicine evaluation and management services) for Medicare services covered by HCPCS codes G0402, G0438, and G0439.
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 the CPT code for routine wellness exam?
An initial Annual Wellness Visit code is documented using G0438, subsequent Annual Wellness Visits are documented using code G0439. The Annual Routine Physical Exam allows members to seek a separate visit with their physician to discuss general health questions/issues without presenting a specific chief complaint.
What is an example of preventive counseling?
Preventive Counseling is used to stop problems before they start or to prevent things from getting worse. Areas like “How to Keep Healthy,” “How to Prepare for Retirement,” or sessions in premarital counseling are examples of preventive counseling.
What does code 99396 mean?
99396. Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 40-64 years.
Do Medicare wellness visits need to be 12 months apart?
Medicare provides coverage of an Annual Wellness Visit (AWV) for a beneficiary who is no longer within 12 months after the effective date of his or her first Medicare Part B coverage period and who has not received either an Initial Preventive Physical Exam (IPPE) or an AWV within the past 12 months.
What is the CPT code for annual gyn Pap exam?
Summary of pap smear billing guidelines
If a clinician is reporting CPT® preventive medicine services, and also performing a screening pap smear report a code in 99381-99397 series and Q0091. Use G0101 and Q0091 for Medicare patients receiving a screening pelvic and breast exam and also a screening pap smear.
Does 99396 include pap smear?
99396, G0101, Q0091 (women's wellness exam, pelvic/breast exam and pap) | Medical Billing and Coding Forum - AAPC.
What is an annual gyno exam called?
The American College of Obstetrics and Gynecologists recommends that you begin receiving your well-woman visit (the standard name for your annual gynecological examination) between 18-21.
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 billing code for preventive visit?
Preventive Medicine Services CPT® Code range 99381- 99429. The Current Procedural Terminology (CPT) code range for Preventive Medicine Services 99381-99429 is a medical code set maintained by the American Medical Association.
Can annual wellness visits be performed via telehealth?
In certain cases, you may be eligible to receive your Annual Wellness via a telehealth appointment. Your provider's office can help determine if you are eligible.
What is the 7 day rule for telehealth?
The communication cannot be related to a medical visit within the previous seven days and cannot lead to medical visit within the next 24 hours (or soonest appointment available). Physician or other clinician may respond to patient by telephone, audio/video, secure text messaging, email, or patient portal.