What is the difference between a preventive visit and an office visit?
Asked by: Dr. Victoria Emard | Last update: July 24, 2025Score: 5/5 (28 votes)
What is considered an office visit for insurance?
What is included in an “office visit?” The purpose of an “office visit” is to discuss, evaluate, and treat a SPECIFIC health concern or condition or chronic problem that has changed. This type of visit may include lab work, X-rays or additional tests related to your health concern.
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 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.
Is annual blood work 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 like iron, kidney or liver function and urinalysis, would not be covered as preventive care.
Front Desk and Scheduling: Office Visit vs. Preventive
What is the difference between preventive and annual 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.
Should routine blood work be covered by insurance?
Diagnostic: Under the Affordable Care Act (ACA), preventive services, which can include some types of blood work, are often fully covered without a copay or coinsurance, even if you haven't met your deductible.
What type of service is not considered to be a preventive medical service?
Alternative therapies: Services such as chiropractic, massage, acupuncture, and other alternative health services are 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;
Do insurance companies cover preventive care?
Most health plans must cover a set of preventive services — like shots and screening tests — at no cost to you. This includes plans available through the Health Insurance Marketplace ®. These services are free only when delivered by a doctor or other provider in your plan's network.
Why did my insurance not cover my doctor visit?
In some cases, the service simply isn't covered by the plan. In other cases, necessary prior authorization wasn't obtained, the provider wasn't in-network, or the claim was coded incorrectly.
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.
Why am I being charged for an office visit?
The purpose of an office visit is to discuss or get treated for a specific health concern or condition. You may have to pay for the visit as part of your deductible, copay and/or coinsurance.
What are the two categories of office visits?
There are two main categories for doctor visits. The first is called E&M (evaluation and management) and is when you need treatment for an active disease such as the flu, ear ache, bladder infection, diabetes or high blood pressure. The second type is a preventive visit, also called a physical or checkup.
Can you bill a preventive visit with a problem 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.
Why am I being charged for preventive care?
Although you don't pay cost-sharing charges when you receive preventive care, the cost of those services is wrapped into the cost of your health insurance. Thus, whether or not you choose to get the recommended preventive care, you're paying for it through the cost of your health insurance premiums anyway.
What is a preventive office visit?
Preventive visits could be an annual physical, well-child exam, Medicare wellness exam or welcome to Medicare visit. Most insurance companies are required to cover preventive care services at no cost to patients. During your appointment, you'll review your overall health and well-being.
What does not preventive include?
- Discussing or getting treatment for a specific health concern, condition or injury.
- Lab work, X-rays or additional tests related to a specific health concern, condition or injury.
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 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.
When visiting your doctor, what are three questions you may want to ask during your visit?
- Why do I take the medications that I do? ...
- What can I do to reduce my risk of cardiovascular disease? ...
- Are my cancer screenings up to date?
Is bloodwork covered by insurance?
Yes, insurance plans usually cover blood work. In fact, the Affordable Care Act (ACA) requires insurance plans to fully cover laboratory costs that are part of preventive care screenings — like a cholesterol screening — when you receive care from an in-network healthcare professional.
Is a CBC considered preventive?
For example, if you're feeling more tired than usual, your doctor might order a complete blood count (CBC) test to help figure out why. Since the test is non-preventive, you'll probably need to pay an extra copay, coinsurance, or deductible payment.
How much is full blood work without insurance?
The cost of a basic metabolic panel test without insurance is higher than a comprehensive metabolic test and ranges between $330 – and $1309. A CMP blood test, in contrast, can cost anywhere between $26.00 and $134.00 without insurance.
Is seeing a dermatologist considered preventive care?
According to the guidelines set by the United States Preventive Services Task Force (USPSTF), skin cancer screenings are not considered to be covered as preventive services. However, a skin cancer screening conducted during a routine annual exam may be considered a form of preventive care.