What is the meaning of procedure code 99396?
Asked by: Shana Hahn DVM | Last update: July 5, 2025Score: 4.7/5 (38 votes)
What is covered under 99396?
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.
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 the code for preventive wellness exam?
2024 CPT Codes for Medicare Annual Wellness Visit: G0402, G0438, G0439. A Medicare Annual Wellness Visit (AWV) is a preventive screening used to identify gaps in care. As covered by Medicare Part B, providers should understand what CPT billing codes matter to the service and how to use them.
Understanding CPT Codes in US healthcare system - Sample CPT Codes
Can 99213 and 99396 be billed 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.
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 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.
Can an annual wellness visit be done 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 reimbursement for S0285?
HCPCS code S0285 describes “Colonoscopy consultation performed prior to a screening colonoscopy procedure” and is recognized by many payers. Since July 2016, it reimburses in the $65 range. When recognized – other payers may prefer 99202-99215.
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.
What is the age limit for 99386?
CPT Code 99386 refers to an intricate preventive evaluation and management (E/M) service tailored for new patients aged between 40 to 64 years. This code is emblematic of a thorough assessment encompassing the patient's health history, risk factors, and potential healthcare requirements.
What is the CPT code for Pap smear?
Coding for a Pap Smear – Points to Note
The CPT codes for cytopathology screening of cervical or vaginal smears are: 88141-88155, 88164-88167, 88174-88175, P3000, P3001, G0123-G0124, and G0141, G0143-G0148 are. The code submitted should reflect the service provided.
Is a yearly gynecological exam considered preventive care?
What are Routine Preventative Care Appointments? They are annual appointments with your gynecologist, and they are an important part of your care with The Group for Women. These annual appointments should begin in your teen years and are especially important when you are sexually active.
What is the procedure code for a physical exam?
The Current Procedural Terminology (CPT®) code 2040F as maintained by American Medical Association, is a medical procedural code under the range - Physical Examination.
Is 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.
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.
How often can you bill an annual wellness visit?
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).
How often should you visit your physician for a wellness visit?
General adult physical schedule: For ages 19-21, once every 2-3 years. For ages 22-64, once ever 1-3 years. Over 65, once a year.
What are the requirements for 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; 40-64 years.
Does Medicare pay for 99396?
As of January 1, 2021, CPT codes 99386 and 99396 will not be paid and will be denied.
What modifier is used for 99396?
In this case, the clinician would report the appropriate preventive service visit (such as 99396) on one line of the claim form, followed by the problem-oriented E/M visit (such as 99213) with modifier 25 appended on the next line.
Is bloodwork considered preventative 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.
How often does insurance cover a colonoscopy?
Screening Colonoscopy:
A test if you are at average-risk for colon cancer. Done every ten years for anyone over age 50* to look for (and remove, if needed) colon polyps. If polyps are not removed, the colonoscopy and sedation are covered 100% by health insurance.
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.