What is the difference between 99385 and 99395?
Asked by: Prof. Bethel Christiansen III | Last update: August 10, 2025Score: 4.2/5 (38 votes)
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 CPT code 99395 used for?
99395 – Preventive Service, est patient 18-39 years (Primary DX – Z00. 0 - annual exam)
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.
What age is 99385 for?
99384 … adolescent (age 12 through 17 years) 99385 …18-39 years.
What is a level 5 office / outpatient visit in medical coding? 99215 & 99205 explained.
What is the age range for 99395?
99395 – established patient, adult 18-39 years. 99397 – established patient, adult 65 years and older.
Does an AWV have to be 12 months apart?
We cover only 1 IPPE per patient per lifetime and 1 additional AWV every 12 months after the date of the patient's last AWV (or IPPE). Check eligibility to find when a patient is eligible for their next preventive service.
Is an annual wellness exam the same as a Pap?
A gynecological (GYN) wellness exam is performed by a medical provider with specialized training in gynecology, the medical specialty for women's reproductive health. The benefits of a yearly visit extend well beyond a Pap smear.
What is not covered in 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.
Does Medicare pay for 99385?
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 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 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 does CPT code 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 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 ...
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 the difference between a wellness exam and an annual exam?
An annual physical exam is more extensive than an AWV. It involves a physical exam by a doctor and includes bloodwork and other tests. The annual wellness visit will just include checking routine measurements such as height, weight, and blood pressure.
What is the CPT code for annual gynecological 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 the difference between an annual and a Pap smear?
What is the difference between a Pap smear and an annual gynecologic exam? A Pap smear is a specific type of cancer screening that often happens during an annual gynecologic or pelvic exam. But it's only one part of the exam. Your provider will advise you on how often you need a Pap smear.
Can an RN perform an AWV?
AWVs can be completed by a provider (i.e., a physician or non-physician practitioner (NPP)), registered nurses (RNs), or other medical professionals (e.g., health educator, registered dietitian) working under direct supervision of a physician or NPP.
Why doesn't Medicare pay for annual physicals?
Annual physicals aren't covered by traditional Medicare because they are excluded by the federal law that governs Medicare. All Medicare plans cover a Welcome to Medicare exam during your first 12 months with Medicare and in subsequent years, an annual wellness exam.
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 the CPT code for annual wellness visit?
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 a prop 56 payment?
Prop56 add-on payment process update
The program provides supplemental payments for certain eligible medical and screening services provided to Medi-Cal beneficiaries. More in depth information on the program can be found on the DHCS Proposition 56 Webpage.