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Healthcare Insights

Top 10 preventive medicine CPT codes

Published Feb 20th, 2023

Preventive medicine is a type of medicine that protects patients and communities from avoidable disability, illness, and death. Healthcare providers offer testing, counseling, and immunizations to prevent illness and identify potential health concerns as they emerge.

Preventive medicine is a vital component of healthcare because it promotes overall wellness, reduces the occurrence of illness, and saves resources.

Using data from the Atlas All-Payor Claims Database , we compiled a list of the top 10 preventive medicine CPT codes below.

Fig. 1 Data is from the Definitive Healthcare Atlas All-Payor Claims Database and represents procedure claims for January – December 2022. Data is accurate as of February 2023.

What was the top preventive medicine CPT code in 2022?

The top preventive medicine CPT code was 99396, a preventive visit for an established patient between ages 40 and 64, representing over 20% of all preventive medicine claims and nearly a quarter of total charges in 2022.

The 40-64 age group is particularly susceptible to conditions like breast cancer, colon cancer, and osteoporosis. Preventive services are especially valuable to patients who face greater risk of illness, whether due to age, comorbidities, lifestyle, or other factors.

The table above also indicates that nearly 80% of preventive medicine claims were for established patients versus new patients. This breakdown shows that most preventive medicine services are for patients who have already received care from the provider.

Why do many people forgo preventive care?

Without health insurance , medical care can be costly and difficult to navigate. For this reason, individuals who do not have health insurance often forgo preventive care. A Bankrate survey found that in 2020, 32% of families in the U.S. did not seek medical care in the past 12 months due to cost.

A study from the CDC found four influencers of preventive care . First, and most prominently, was finances, followed by the use of metrics driving change in the healthcare system, and the role of healthcare payors . The final influencing factor was changes in healthcare reimbursement models.

Individuals who do not receive preventive care are at increased risk for disabilities, diseases, and death .

What is a CPT code?

The Current Procedural Terminology (CPT) is a system of codes used for reporting healthcare services and medical procedures. CPT codes increase the efficiency and accuracy of healthcare reporting and billing.

Definitive Healthcare tracks many CPT codes across diagnostic, medical, and surgical areas. This information can give you insight into diagnosis, procedure, and prescribing activity and transform your sales and marketing strategies.

Learn more

To hear more about the long-term implications of pandemic-related delays in care, including preventive care, listen to our podcast with Dr. Mark Pimentel .

Healthcare Insights are developed with  healthcare commercial intelligence  from the Definitive Healthcare platform. Want even more insights? Start a  free trial  now and get access to the latest healthcare commercial intelligence on hospitals, physicians, and other healthcare providers.

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Top 10 Preventive Medicine CPT Codes

"Welcome to Medicare" preventive visit

Medicare Part B (Medical Insurance) covers a “Welcome to Medicare” preventive visit once within the first 12 months you have Part B.

Your costs in Original Medicare

You pay nothing for the visit if your doctor or other health care provider accepts assignment . The Part B deductible doesn’t apply.

However, you may have to pay coinsurance , and the Part B deductible may apply if your doctor or other health care provider performs additional tests or services during the same visit that Medicare doesn't cover under this preventive benefit. If Medicare doesn't cover the additional tests or services (like a routine physical exam), you may have to pay the full amount.

Your doctor or other health care provider may recommend you get services more often than Medicare covers. Or, they may recommend services that Medicare doesn’t cover. If this happens, you may have to pay some or all of the costs. Ask questions so you understand why your doctor is recommending certain services and if, or how much, Medicare will pay for them.

This visit includes a review of your medical and social history related to your health. It also includes education and counseling about preventive services, including these:

Certain screenings, flu and pneumococcal shots, and referrals for other care, if needed.
Height, weight, and blood pressure measurements.
A calculation of your body mass index.
A simple vision test.
A review of your potential risk for depression and your level of safety.
An offer to talk with you about creating advance directives.
A written plan letting you know which screenings, shots, and other preventive services you need. Get details about coverage for screenings, shots, and other preventive services.

Things to know

When you make your appointment, let your doctor’s office know you would like to schedule your “Welcome to Medicare” preventive visit. Bring the following to your appointment:

Medical records, including immunization records.
Family health history.
A list of any prescription drugs, over-the-counter drugs, vitamins, and supplements that you currently take, how often you take them, and why.

Related resources

Medicare & You: women's health (video)
Yearly "Wellness" visits

Is my test, item, or service covered?

CPT CODE 99381, 99382 – 99385 – Preventive visit new patient

Sep 25, 2016 | Medical billing basics

CPT Code and description

99381 – Initial comprehensive preventive medicine evaluation 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, new patient; infant (age younger than 1 year)

99382 – Initial comprehensive preventive medicine evaluation 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, new patient; early childhood (age 1 through 4 years)

99383 – Initial comprehensive preventive medicine evaluation 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, new patient; late childhood (age 5 through 11 years) – Average fee amount $110 – $130

99384 – Initial comprehensive preventive medicine evaluation 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, new patient; adolescent (age 12 through 17 years) Average fee amount $120 – $140

99385 – Initial comprehensive preventive medicine evaluation 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, new patient; 18-39 years – Average fee amount – $120 – $ 150

Preventive Medicine Services [Current Procedural Terminology (CPT®) codes 99381-99387, 99391-99397 , Healthcare Common Procedure Coding System (HCPCS) code G0402] are comprehensive in nature, reflect an age and gender appropriate history and examination, and include counseling, anticipatory guidance, and risk factor reduction interventions, usually separate from disease-related diagnoses. Occasionally, an abnormality is encountered or a preexisting problem is addressed during the Preventive visit, and significant elements of related Evaluation and Management (E/M) services are provided during the same visit. When this occurs, Oxford will reimburse Preventive Medicine service plus 50% the Problem-Oriented E/M service code when that code is appended with modifier 25. If the Problem-Oriented service is minor, or if the code is not submitted with modifier 25 appended, it will not be reimbursed.

When a Preventive Medicine service and Other E/M services are provided during the same visit, only the Preventive Medicine service will be reimbursed.

Screening services include cervical cancer screening; pelvic and breast examination; prostate cancer screening/digital rectal examination; and obtaining, preparing and conveyance of a Papanicolaou smear to the laboratory. These Screening procedures are included in (and are not separately reimbursed from) the Preventive Medicine service rendered on the same day.

Prolonged services are included in (and not separately reimbursed from) Preventive Medicine codes.

Counseling services are included in (and not separately reimbursed from) Preventive Medicine codes.

Medical Nutrition Therapy services are included in (and not separately reimbursed from) Preventive Medicine codes.

Visual function screening and Visual Acuity screening are included in (and not separately reimbursed from) Preventive Medicine services.

For a list of specific codes that are included in (and not separately reimbursed from) Preventive Medicine Services see the Applicable Codes section below.

For the purposes of this policy, Same Specialty Physician, Hospital, Ambulatory Surgical Center or Other Health Care Professional is defined as a physician, hospital, ambulatory surgical center, and/or other health care professional of the same group and Same Specialty Physician, Hospital, Ambulatory Surgical Center or Other Health Care Professional reporting the same Federal Tax Identification number.

PREVENTIVE MEDICINE SERVICES, NEW PATIENT

Initial comprehensive preventive medicine evaluation and management of an individual including an age- and gender-appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of appropriate immunizations, laboratory/diagnostic procedures for a new patient.

Code Description

99381 Infant (age under 1 year) 99382 Early childhood (ages 1 through 4 years) 99383 Late childhood (ages 5 through 11 years) 99384 Adolescent (ages 12 through 17 years) 99385 18–39 years 99386 40–64 years 99387 65 years and over

PREVENTIVE MEDICINE SERVICES, ESTABLISHED PATIENT

Periodic comprehensive preventive medicine re-evaluation and management of an individual, including an age- and gender-appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of appropriate immunizations, laboratory/diagnostic procedures for an established patient.

Code Description 99391 Infant (age under 1 year) 99392 Early childhood (ages 1 through 4 years) 99393 Late childhood (ages 5 through 11 years) 99394 Adolescent (ages 12 through 17 years) 99395 18–39 years 99396 40–64 years 99397 65 years and over

New versus Established client: A new client is defined as one who has not received any professional services from a physician/qualified health care professional in your health department, within the last three years, for a billable visit that includes some level of evaluation and management (E/M) service coded as a preventive service using 99381-99387 or 99391-99397, or as an evaluation & management service using 99201-99205 and 99211-99215. If the client’s only visit to the Health Department is WIC or immunizations without one of the above service codes, it does not affect the designation of the client as a new client; the client can still be NEW. Remember that a client may be new to a program but established to the health department if they have received any professional services from a physician/qualified health care professional.

In this case, you would use the forms for a “new” patient for that program even though the client is billed as “established” to the health department. Due to National Correct Coding Initiative (NCCI) edits the practice of billing a 99211, and then later billing a new visit code, has been eliminated. Many LHDs have been billing a 99211 (usually an RN only visit) the first time they see a patient and then, up to 3 years later, bills a 99201 – 99205 or 99381-99387 (New Visit). Examples may include: billing the 99211 for pregnancy test counseling or head lice check by RN and then a new visit when the patient comes in for their first prenatal, Family Planning or Child Health visit. Now that the NCCI edits have been implemented, all of those “new” visits will deny because the LHD will have told the system (via billing a 99211) that the patient is “established.” Consult your PHNPDU Nursing Consultant if you have questions.

ADULT PREVENTIVE CARE PROCEDURE CODES

Code Description 76091 Mammogram (specialty center) 82270 Fecal Occult Blood Test (lab procedure code only) 82465 Total Serum Cholesterol (lab procedure code only) 84153 PSA (lab procedure code only) 86580 Tuberculosis (TB) Screening (PPD) 88150 Pap Smear (lab procedure code only) 90658 Flu Shot 90718 Td-Diphtheria–Tetanus Toxoid–0.5 ml 90732 Pneumovax

REIMBURSEMENT GUIDELINES Preventive Medicine Service and Problem Oriented E/M Service

A Preventive Medicine CPT or HCPCS code and a Problem-Oriented E/M CPT code may both be submitted for the same patient by the Same Specialty Physician, Hospital, Ambulatory Surgical Center or Other Health Care Professional on the same date of service. If the E/M code represents a significant, separately identifiable service and is submitted with modifier 25 appended, Oxford will reimburse the Preventive Medicine code plus 50% of the Problem-Oriented E/M code. Oxford will not reimburse a Problem-Oriented E/M code that does not represent a significant, separately identifiable service and that is not submitted with modifier 25 appended.

Preventive Medicine Service and Other E/M Service

A Preventive Medicine CPT or HCPCS code and Other E/M CPT or HCPCS codes may both be submitted for the same patient by the Same Specialty Physician, Hospital, Ambulatory Surgical Center or Other Health Care Professional on the same date of service. However, Oxford will only reimburse the Preventive Medicine CPT or HCPCS code.

QUESTIONS AND ANSWERS 1 Q: Why does Oxford reduce reimbursement to 50% for an evaluation and management (E/M) service (99201-99205 or 99212-99215 with modifier 25) billed for the same person on the same date of service as a Preventive Medicine service ?

A: Oxford recognizes that a visit may begin as a Preventive Medicine service, and in the process of the examination it may be determined that a disease related condition exists (evaluation and management). When this occurs, the level of decision-making during such a visit may be more complex than the decision-making during a Preventive Medicine visit. However, there are elements of the Preventive Medicine service (e.g., making the appointment, obtaining vital signs, maintaining and stocking the exam room, etc.) that are duplicated in the reimbursement for an E/M code; these duplicated practice expense services are 50% of the E/M cost.

2 Q: In what situation is CPT code 96110 reimbursable?

A: As defined, CPT code 96110 represents developmental screening with interpretation and report. In the introduction to the section in which this code appears, the CPT book states that “it is expected that the administration of these tests will generate material that will be formulated into a report.” Because a physician obtains developmental information as an intrinsic part of a preventive medicine service for an infant or child and because this information is sometimes obtained in the form of a questionnaire completed by the parents, it is expected that this code will be reported in addition to the preventive medicine visit only if the screening meets the code description. Physicians should report CPT code, for developmental screening or other similar screening or testing, separate and distinct from the Preventive medicine service only when the testing or screening results in an interpretation and report by the physician being entered into the medical record.

3 Q: Why is Q0091 not separately reimbursable when billed with a Preventive Medicine code?

A: Oxford considers Q0091 (obtaining, preparing and conveying a cervical or vaginal smear to the laboratory) to be an integral part of a Preventive Health Care service. Therefore, this component of a Preventive visit is not separately reimbursable.

4 Q: Why is 99173 (screening test of visual acuity) not separately reimbursable when billed with a Preventive Medicine code?

A: Oxford considers vision screening using an eye chart to be integral to a Preventive Medicine examination in the same way that measurements of height, weight and blood pressure are integral to a Preventive Medicine examination. Therefore, vision screening using an eye chart is not reimbursed separately from a Preventive Medicine examination.

5 Q: Why is 99172 (visual function screening) not separately reimbursable when billed with a Preventive Medicine code?

A: The CPT Book clearly states that this service should not be reported in addition to an E/M code.

6 Q: How does Oxford reimburse for screening tests based on a questionnaire completed by the patient or a family member when done in conjunction with a Preventive Medicine service?

A: Counseling, anticipatory guidance and risk factor reduction interventions are integral to a Preventive Medicine visit. Historical information may be obtained either through direct questioning or through completion of a written questionnaire. The responses on a questionnaire often identify areas for more focused interventions or treatments. Since this screening is part of a Preventive Medicine service, it is not reimbursed separately. Occasionally, a screening instrument requires interpretation, scoring, and the development of a report separate from the Preventive Medicine encounter. In those situations, where a CPT code exists for that service, screening, interpretation and development of a report is reimbursed separately from a Preventive Medicine service. State Exceptions

Arizona Per Arizona State Regulations, effective 4/1/14 claims for EPSDT services must be submitted on a CMS (formerly HCFA) 1500 form for members up to age 21. Providers must bill for preventative EPSDT services using the preventative service, office or other outpatient services and preventive medicine CPT codes (99381 – 99385, 99391 – 99395) with an EP modifier.

EPSDT visits are paid at a global rate for the services specified and no additional reimbursement is allowed. Providers must use an EP modifier to designate all services related to the EPSDT well child check-ups, including routine vision and hearing screenings.

* A list of preventative, office or other outpatient services that are considered included in the global payment of the preventive medicine CPT code is attached to this policy

* Ocular photoscreening with interpretation and report, bilateral (CPT code 99174) is allowed for members under age 19. Arizona EPSDT Bundled Codes Lis t

A list of preventative, office or other outpatient services that are considered included in the global payment for the preventive medicine CPT codes (99381 – 99385, 99391 – 99395).

DC EPSDT Well-Child Visit Billing Reference Guide

When conducting a well-child visit (WCV), a primary care provider (PCP) must perform all components required in a visit and all age-appropriate screenings and/or assessments as required in the DC Medicaid HealthCheck Periodicity Schedule. Covered screening services are medical, developmental/mental health, vision, hearing and dental. The components of medical screening include:

* Comprehensive health and developmental history that assesses for both physical and mental health as well as for substance use disorders

* Comprehensive, unclothed physical examination

* Appropriate immunizations (as established by ACIP)

* Laboratory testing (including blood lead screening appropriate for age and risk factors)

* Health education and anticipatory guidance for both the child and the caregiver.i

To bill for a well-child visit:

* Use the age-based CPT code (99381-99385; 99391-99395). See Table 1.

o Use the following ICD-9 diagnosis codes listed in Table 1 in conjunction with the CPT Code

* Bill for each separate assessment/screening performed using the applicable CPT code from Table 2.

* If a screening or assessment is positive and requires follow-up or a referral, please use modifier TS with the applicable screening code that had a positive result.

DO NOT USE THE E&M OUTPATIENT VISIT CODES (99201-99205; 99213-99215) TO BILL FOR A WELLCHILD VISIT.

Table1: Age Based Preventive Visit CPT Codes Table 2: Screening/Assessment CPT Codes Patient’s Age CPT Code Dx Code

< 1 year 99381/91 new/established V20.31, 20.32, V20.2

1 – 4 years 99382/92 V20.2

5 – 11 years 99383/93 V20.2

12 – 17 years 99384/94 V20.2

18 – 21 years 99385/95 V70.0

HCY/EPSDT Billing Codes [1][2][3] AGE CPT Code: New Patient AGE CPT Code:

Established Patient Modifiers As Applicable ICD-10-CM Diagnosis Codes Preventive visit, Modifier EP: Used with procedure codes 99381-99385 and 99391-99395 when a Full or Partial screening is performed.

Modifier 52: Used with modifier EP when all components have not been met, but at least the first 5 or more components were completed according to the HCY/EPSDT requirements.

Modifier 59: Used when only components related to developmental and mental health are screened.

Modifier 25: Used on the significant, separately identifiable problem-oriented evaluation and management service when it is provided on (1) the same day as the preventive medicine service and/or (2) with administration of immunizations. Please note that modifier 25 is not to be used on preventive codes and needs to be billed using office or outpatient codes (99201-99215), and that these screenings bundle administration of immunizations.*Documentation must support the use of a modifier 25. See MO HealthNet Provider Manual. Modifier UC: Used when a referral is made for further care.

Z00.110 Newborn under 8 days old

Z00.111 Newborns 8 to 28 days old or

Z00.121 Routine child health exam with abnormal findings

Z00.129 Routine child health exam without abnormal findings Preventive visit, 1-4

99382 Preventive visit, 1-4

99392 Z00.121 Z00.129 Preventive visit, 5-11

99383 Preventive visit, 5-11

99393 Z00.121 Z00.129 Preventive visit, 12-17

99384 Preventive visit, 12-17

99394 Z00.121 Z00.129 Preventive visit, 18 or older

99385 Preventive visit, 18 or older

99395 Z00.00 General adult medical exam without abnormal findings Z00.01 General adult medical exam with abnormal findings

NCCI Edit with preventive visits

National Correct Coding Initiative (NCCI) Impacts on Immunization and Evaluation & Management (E&M) Codes Effective April 1, 2014, the Department will no longer reimburse NCCI procedure-to-procedure (PTP) edits when immunization administration procedure codes (CPT 90460-90474) are paired with preventative medicine E&M service procedure codes (CPT 99381-99397).

If a significant separately identifiable E&M service (e.g. new or established patient office or other outpatient services [99201-99215], office or other outpatient consultation [99241-99245], emergency department service [99281-99285], preventative medicine service [99381-99429] is performed), the appropriate E&M service code should be reported in addition to the vaccine and toxoid administration codes.

Each NCCI PTP edit has an assigned modifier indicator. A modifier indicator of “0” indicates that NCCI PTP-associated modifiers cannot be used to bypass the edit. A modifier indicator of “1” indicates that NCCI PTP-associated modifiers may be used to bypass an editunder appropriate circumstances. A modifier indicator of “9” indicates that the edit has been deleted, and the modifier indicator is not relevant. The Correct Coding Modifier Indicator can be found in the files containing Medicaid NCCI PTP edits on the CMS website.

A modifier should not be added to a HCPCS/CPT code solely to bypass an NCCI PTP edit, if the clinical circumstances do not justify its use. If the E&M service is significant and separately identifiable and performed on the same day, the E&M code should be billed with the vaccine and toxoid administration codes using PTP associated modifier ‘25’. Modifier ‘25’ is only valid when appended to the E&M codes. Do not append to the immunization administration procedure codes 90460-90474.

Therapeutic Injections Office visits (CPT codes 99201-99205; 99212-99215; 99381-99397) will not be separately reimbursed when submitted with therapeutic injections (CPT code 96372). Please append Modifier 25 to the disallowed E/M code if a significant separately identifiable E/M service was performed. Note: CPT code 96372 has been valued to include the work and practice expenses of CPT code 99211. A modifier will not override this edit.

Visual Acuity Testing CPT code 99173, visual acuity screening test, is separately reimbursable when submitted with preventive office visits (CPT codes 99381-99397). Vital Capacity Vital capacity (CPT code 94150) is considered incidental to the overall service provided, whether an office visit or a procedure, and will not be separately reimbursed.

Payment guidelines

Preventive Medicine Services [Current Procedural Terminology (CPT®) codes 99381-99387, 99391-99397, Healthcare Common Procedure Coding System (HCPCS) code G0402] are comprehensive in nature, reflect an age and gender appropriate history and examination, and include counseling, anticipatory guidance, and risk factor reduction interventions, usually separate from disease-related diagnoses. Occasionally, an abnormality is encountered or a preexisting problem is addressed during the Preventive visit, and significant elements of related Evaluation and Management (E/M) services are provided during the same visit. When this occurs, Oxford will reimburse thePreventive Medicine service plus 50% the Problem-Oriented E/M service code when that code is appended with modifier 25. If the Problem-Oriented service is minor, or if the code is not submitted with modifier 25 appended, it will not be reimbursed.

Prolonged services are included in (and not separately reimbursed from) Preventive Medicine codes. Counseling services are included in (and not separately reimbursed from) Preventive Medicine codes. Medical Nutrition Therapy services are included in (and not separately reimbursed from) Preventive Medicine codes. Visual function screening and Visual Acuity screening are included in (and not separately reimbursed from) Preventive Medicine services.

Reporting Evaluation and Management Services With Immunizations

E/M services most often reported with the vaccine product and immunization administration include new and established patient preventive medicine visits (CPT codes 99381–99395), problem-oriented visits ( CPT 99201 –99215), and preventive medicine counseling services (99401–99404). Any of the aforementioned E/M codes can be reported as a single service or in combination when performed and documented on the same day of service by the same physician or physician of the same group and specialty.

The E/M service must be medically indicated, significant, and separately identifiable from the immunization administration.

• Payers may require modifier 25 (significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) to be appended to the E/M code to distinguish it from the administration of the vaccine.

• CPT code 99211 (established patient E/M, minimal level, not requiring physician presence) should not be reported when the patient encounter is for vaccination only because the Medicare Resource-BasedRelative Value Scale (RBRVS) relative values for the immunization administration codes incl de administrative and clinical services (ie, greeting the patient, routine vital signs, obtaining a vaccine history, presenting the VIS and responding to routine vaccine questions, preparation and administration of the vaccine, and documentation and observation of the patient following the administration of the vaccine). However, if the service is medically necessary, significant, and separately identifiable, it may be reported with modifier 25 appended to the E/M code (99211). Note that the medical record must clearly state the reason for the visit, brief history, physical examination, assessment and plan, and any other counseling or discussion items. The progress note must be signed with the physician’s countersignature. For more information and clinical vignettes on the appropriate use of code 99211 during immunization administration, visit www.aap.org/pubserv/codingforpeds for a copy of the AAP position paper on reporting 99211 with immunization administration. Payers who do not follow the Medicare RBRVS may allow payment of code 99211 with immunization administration. Know your payer guidelines, and if payment is allowed, make certain that the guidelines are in writing and maintained in your office. Be aware that a co-payment will be required when the “nurse” visit is reported.

• The same guidelines apply to physician visits (99201–99215). In other words, if a patient is seen for the administration of a vaccine only, it is not appropriate to report an E/M visit if it is not medically necessary, significant, and separately identifiable.

• If at the time of a preventive medicine visit a patient has a problem or abnormality that is addressed and requires significant additional work to perform the required key components, a problem-oriented E/M code (99201–99215) may be reported in addition to the preventive medicine services code. There should be separate documentation for the 2 services in the medical record. Typically the level of service is based on the level of history and medical decision-making that are performed and documented because the physical examination component is most often performed as part of the age-appropriate examination included in the preventive medicine service. Modifier 25 must be appended to the problemoriented E/M service to alert the payer that it was significant and separately identifiable. Each code is linked to the appropriate ICD-9-CM code.

CPT codes 99401–99404 (preventive medicine counseling, individual) are used for the purpose of promoting health and preventing illness or injury. They are not reported when counseling is related to a condition, disease, or treatment. These are time-based codes that require medical record documentation of the total time spent in counseling and a summary of the issues discussed. Codes 99401–99404 may be reported separately from other E/M services (eg, office visits, preventive medicine visits) when performed on the same day. Modifier 25 must be appended to codes 99401– 99404 to signify to the payer that the preventive medicine counseling was significant and separately identifiable from the preventive medicine or problem-oriented E/M visit.

• Remember that reviewing or discussing the risks and benefits of vaccines and addressing all other patient and parent concerns and questions related to vaccines and immunization administration are included in the immunization administration codes. However, if vaccine counseling is performed and the parent or patient refuses vaccines, the time spent in counseling may be separately reported. Also, if after additional time is spent in vaccine counseling, the parent or patient then decides to accept the immunizations and the time and effort exceeds that normally spent by the physician, it is still appropriate to report these codes in addition to the E/M visit and immunization administration. Make certain that the medical record supports the excess time and effort of counseling.

Billing for Medically Necessary Visit on Same Occasion as Preventive Medicine Service

When a physician furnishes a Medicare beneficiary a covered visit at the same place and on the same occasion as a noncovered preventive medicine service (CPT codes 99381- 99397), consider the covered visit to be provided in lieu of a part of the preventive

medicine service of equal value to the visit. A preventive medicine service (CPT codes 99381-99397) is a noncovered service. The physician may charge the beneficiary, as a charge for the noncovered remainder of the service, the amount by which the physician’s current established charge for the preventive medicine service exceeds his/her current established charge for the covered visit. Pay for the covered visit based on the lesser of the fee schedule amount or the physician’s actual charge for the visit. The physician is not required to give the beneficiary written advance notice of noncoverage of the part of the visit that constitutes a routine preventive visit. However, the physician is responsible for notifying the patient in advance of his/her liability for the charges for services that are not medically necessary to treat the illness or injury.

There could be covered and noncovered procedures performed during this encounter (e.g., screening x-ray, EKG, lab tests.). These are considered individually. Those procedures which are for screening for asymptomatic conditions are considered noncovered and, therefore, no payment is made. Those procedures ordered to diagnose or monitor a symptom, medical condition, or treatment are evaluated for medical necessity and, if covered, are paid.

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PREVENTIVE MEDICINE VISITS

Preventive medicine visits (CPT codes 99381-99397) are for patients covered by commercial insurance, Medicaid plans, and some Medicare Advantage plans. Patients value these visits because they are not subject to co-pays and deductibles. After age two, one preventive visit is covered annually.

According to CPT, preventive medicine visits are “comprehensive preventive medicine evaluation and management services 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.”

Codes 99381-99387 are for new patients and 99391-99397 are for established patients. Both are further broken down by age group. The extent of the exam, the content of the counseling and anticipatory guidance, and the recommended screenings and immunizations vary depending on the patient's age and gender. “Comprehensive” in the CPT definition is not synonymous with the comprehensive exam required in other E/M services. This is a common misconception among physicians and patients alike.

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. If a patient comes in for a preventive visit and the clinician also looks at a rash or notices the patient's blood pressure is elevated, these observations alone are not enough to bill a problem-oriented E/M visit. There must be some medical decision making (MDM) that occurs, such as prescribing a topical treatment for the rash or choosing not to prescribe a medication for the high blood pressure and instead suggesting the patient change his diet.

Once you've documented your MDM, you can bill an E/M visit using codes 99202-99215 with the preventive medicine visit code. Make sure to add modifier 25 to the E/M code to signal to the payer that two distinct visits were done on the same day.

For more details on when to bill both visits, how to level the E/M portion, and what to include in your documentation, see “ One visit or two? ”

ONE VISIT OR TWO?

Medicare wellness visits.

Original (traditional) Medicare does not cover CPT codes 99381-99397, because Medicare has its own wellness visits with their own “G” codes and requirements. As mentioned, some Medicare Advantage plans do cover the preventive medicine CPT codes in addition to Medicare wellness visits. However, a Medicare wellness visit and a preventive visit should not be billed on the same date of service. Medicare developed the Initial Preventive Physical Examination (IPPE, also known as the “Welcome to Medicare” visit) (G0402) and initial and subsequent annual wellness visits (G0438 and G0439) to encourage Medicare patients to receive screenings and preventive care, and to work with their physicians to develop a personalized prevention plan. 1 The requirements are slightly different for the three codes, but in general they require collecting or updating medical, family, and social history; screening for depression; evaluating the patient's ability to perform activities of daily living; assessing the patient's safety at home; recording vital signs; asking about opioid and substance use; and providing guidance about preventive services and a personalized prevention plan (for more details, see the table in “ Medicare 101: Navigating the Rules for Coverage and Benefits in Clinical Practice ”). Similar to CPT's preventive medicine visits, Medicare wellness visits do not require a full head-to-toe physical exam.

The assessment and management of acute or chronic problems are not components of the IPPE or annual wellness visits. When that service is medically necessary during a Medicare wellness visit, the physician can also bill for a problem-oriented E/M office visit on the same day, again using the appropriate CPT code (99202-99215) with modifier 25.

SELECTING THE LEVEL OF SERVICE FOR THE E/M CODE

Hopefully you're now familiar with the E/M coding rules that changed in 2021. 2 Performing a problem-oriented E/M service on the same date as a wellness visit adds a layer of complexity when it comes to choosing the level of service for the E/M code. But, as mentioned, the new rules actually make it easier than it was before.

When selecting a code (99202-99215) using the new E/M guidelines for office and outpatient services, physicians may use either total time on the date of the visit or MDM. History and exam are no longer necessary to select the level of service (though they should still be documented to provide the best care). This makes it easier to select a level of service for the problem-oriented visit when it's combined with a wellness or preventive visit because there are fewer overlapping components when coding based on MDM. The E/M service is your assessment and management of an acute or chronic condition, which is not required in either CPT preventive services or Medicare wellness visits.

It's trickier to code the E/M service based on time because you must make sure to only count the time spent managing the problems, not the time spent on the preventive or wellness service. The February 2021 CPT Assistant newsletter was particularly clear on this, stating “if time is used for selection of a level of the office/outpatient E/M code, the time spent on the preventive service cannot be counted toward the time of the work of the problem assessment because time spent performing a service cannot be counted twice. The code for the problem-assessment portion of the encounter will likely be selected based on MDM.” 3 It might make sense to consider MDM-based coding as the best practice when combining E/M visits with wellness visits.

A problem-oriented visit includes the history of the problem and any symptoms or complaints related to it. It may or may not include a physical exam or data review (e.g., notes reviewed, tests ordered, tests reviewed, or independent historian). It includes the evaluation and management of a problem or condition. When these components are documented in addition to the preventive visit, add a problem-oriented visit code. For more on which components are required for which visits, see “ How to credit combined visits .”

Let's look at some examples of when it would be appropriate to bill for a problem-oriented E/M code (CPT 99202-99215) along with a preventive or wellness visit.

Patient 1: A 70-year-old male, established patient with a history of diabetes and hyperlipidemia comes in for a Medicare annual wellness visit. All required components of the wellness visit are completed. The patient then asks for a refill of his diabetes medication. The physician asks the patient if he is taking his medication as prescribed and following the diet recommendations discussed during the last visit. The physician also performs a focused physical exam, discusses medication management for diabetes and hyperlipidemia, and orders maintenance labs. The physician documents her significant review of the patient's problems, bills for the annual wellness visit with code G0439, and adds a 99214 E/M code because she addressed two stable chronic illnesses and performed prescription drug management. She adds modifier 25 to the E/M code.

Patient 2: A 32-year-old female, new patient comes in for a preventive medicine visit required by her employer. The physician completes all requirements for the preventive visit. During the history portion, the patient tells the physician that she has been having some knee pain exacerbated by running. The physician obtains additional history about the pain, examines her knee, tells her to reduce her running until the pain subsides, and gives her a handout on knee exercises. He also recommends she try a knee brace and follow up if the pain does not lessen with rest. The physician documents the extra work done to address the knee issue, then bills code 99385 for an initial preventive medicine visit for a patient age 18–39, along with E/M code 99203 because he addressed one acute, uncomplicated injury. He adds modifier 25 to the E/M code.

Patient 3: A 49-year-old female, established patient comes in for her annual preventive visit. The physician completes all requirements for the preventive visit. The patient then mentions she has been excessively tired recently and has been having trouble sleeping. The physician obtains a detailed history of the problems, does a thorough physical exam, and orders some labs (complete blood count and thyroid-stimulating hormone). The physician documents the extra work, then bills code 99396 for a periodic preventive medicine visit for a patient age 40–64 and E/M code 99213 for addressing two acute illnesses (fatigue and insomnia) and ordering two labs. The physician adds modifier 25 to the E/M code.

WORKFLOW TIPS

It's hard to plan for surprise problems that come up during a preventive or wellness visit. But your staff can help by asking patients up front if they have any other issues that need to be addressed. This step should occur when staff are scheduling or confirming patient visits, allowing you to block off more time if necessary.

Scheduling staff should also be aware that Medicare wellness visits have strict rules about how often they can be billed. They must be separated by at least 12 months from the previous wellness visit. Having staff check eligibility for Medicare wellness visits using the HIPAA Eligibility Transaction System can help you avoid denials. 4 The timeframes for CPT preventive visits are more forgiving; they can be performed once every plan year (usually a calendar year, but some plans vary).

Patients who know their preventive/wellness visit will be covered with no deductible or co-pay may mistakenly assume all services provided during that visit, including E/M, will be no cost to them. It is best to educate patients on the costs associated with a problem-oriented office visit and let them know that performing one with a preventive or wellness visit will result in the same co-pay they would incur if the problem-oriented visit was on a different day. Most patients will accept this, because getting both visits in the same trip is more convenient for them. Posting flyers in the exam rooms or waiting room about the difference between preventive/wellness visits and problem-oriented visits, and the costs associated with each, can also prevent patient dissatisfaction.

Physicians could ask these patients to return for the problem-oriented visit on another day, but if time allows for providing both services at the current visit, it is only fair and reasonable to do so. Knowing the rules for combined visits, and the convenience they offer patients, should give physicians the confidence to bill fully for their services.

The ABCs of the Initial Preventive Physical Examination. Medicare Learning Network. Accessed Nov. 15, 2021. https://www.mvphealthcare.com/wp-content/uploads/download-manager-files/CMS-ABC-Initial-Preventive-Physical-Examination-ICN006904-01-2015.pdf

Millette KW. Countdown to the E/M coding changes. Fam Pract Manag . 2020;27(5):29-36.

Evaluation and management (E/M) 2021; AMA CPT Assistant . 2021;2:7-8.

HIPAA Eligibility Transaction System (HETS). Centers for Medicare & Medicaid Services. Updated Oct. 25, 2021. Accessed Nov. 15, 2021. https://www.cms.gov/research-statistics-data-and-systems/cms-information-technology/hetshelp

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500 Items and Services

500 Items and Services List for Price Comparison Tool

This page has been archived. It was last updated on 6/23/2023. Starting January 1, 2024, price comparison tools must display information for all covered items and services.

(801) 429-8000

[email protected]

1055 North 500 West Provo, UT 84604

We want to help you make the best decisions for your health

Revere Health believes all patients should have access to information that helps them make educated healthcare decisions, including information about the cost of care. That’s why we’ve created pricing charts that highlight the most common procedures in each specialty and what they cost at any Revere Health location.

We're happy to discuss the specifics of your bill with you if you have any questions.

The pricing information below* represents the “sticker price” of a particular procedure or service for someone without insurance. Uninsured patients are eligible to receive a 30% discount on the sticker price for prompt payment on everything but drugs. Patients with health insurance will typically be charged an amount less than the sticker price (the exact cost varies based on individual insurance plans). The average patient experience also results in some additional testing or services that could appear on your bill. Financial Consideration Financial issues should not prevent our community members from receiving the medical treatment they need. Revere Health is committed to helping everyone get care by offering financial assistance to those who qualify. To apply for financial assistance, click the link below and fill out the form. Please return the form to [email protected] or to Patient Services: located at 1055 N 500 W Suite 102, Provo UT 84604.

Good Faith Estimate

Under federal law, patients can request a “Good Faith Estimate” of their bill before healthcare services are provided. This estimate will explain how much your healthcare services or items will cost and will include related costs like medical tests, prescription drugs, equipment, and hospital fees. Currently, this is only applicable for patients who don’t plan to use health insurance (self-pay) or who do not have health insurance (uninsured)*. If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill. Call 801-429-8000 for more information or if you would like to obtain a Good Faith Estimate from Revere Health. *Some exceptions. For general questions or more information about your right to an estimate, visit www.cms.gov/nosurprises/consumers , email [email protected] , or call 1-800-985-3059 .

Estimado de buena fe

Office Visits

There are several different levels of office visits, and the price for each level of office visit is the same across all Revere Health specialties. Without seeing you in the exam room first, however, it’s difficult to know exactly which level of service will apply to your office visit.

A Level 1 visit is a simple visit that may not require the presence of a physician. A Level 5 visit involves a comprehensive evaluation of serious/worsening problems that require complex medical decision making. Your office visit could fit anywhere on this scale depending on your individual health situation.

Established Patients

Office Visit Complexity

New Patients

Search by specialty, adult and adolescent medicine.

Immunization admin

Administration of a single immunization that does not involve face-to-face counseling.

Drain/inj joint/bursa w/o us

Fluid removal in a major joint without the use of ultrasound technology.

Admin influenza virus vac

Administration of influenza vaccine.

Initial hospital care

Initial evaluation of a patient in the hospital requiring complex medical decision making and a comprehensive exam (Level 3).

Subsequent hospital care

Follow up evaluation and management of a patient in the hospital requiring moderate-complexity medical decision making (Level 2).

Iiv no prsv increased ag im

Preservative-free, high-dose Fluzone (influenza) vaccine.

Follow up evaluation and management of a patient in the hospital requiring low-complexity medical decision making (Level 1).

Methylprednisolone 40 mg inj

Methylprednisolone injection (brand names: A-Methapred, Depo-Medrol, SoluMEDROL) typically used to treat pain and swelling.

Hospital discharge day

Management of patient health on hospital discharge day.

Md inr test revie inter mgmt

Physician review, interpretation and management of home INR testing (to monitor blood thinning medications).

Allergy and Immunology

Ther/proph/diag inj sc/im

Therapeutic, prophylactic and diagnostic injections and infusions used for treatment, prevention and diagnosis (excludes chemotherapy and other complex medications.

Allergy patch tests

Allergy test in which a patch with a possible allergen is placed onto the skin. Charge is per allergen.

Evaluation of wheezing

Breathing capacity test after receiving a medication that widens the air passages into the lungs.

Breathing capacity test

Non-invasive evaluation of how quickly and how much air you exhale.

Perq&ic allg test drugs/biol

Skin allergy test to identify allergic reactions to medications or biologic agents used to treat or diagnose a disease.

Icut allergy test drug/bug

Intradermal (between layers of skin) allergy test in which the extract of a possible allergen (medication or insect venom) is injected into the skin. Charge is per allergen.

Immunotherapy one injection

Single immunotherapy injection. Does not include preparation of vial.

Immunotherapy injections

Multiple immunotherapy injections. Does not include preparation of vial.

Antigen therapy services

Preparation by an allergist of an immunotherapy injection.

Percut allergy skin tests

Percutaneous (through the skin) allergy test in which a drop of a possible allergen is pricked or scratched into the skin. Charge is per allergen.

Dermatology

Triamcinolone acet inj nos

Steroid injection that decreases inflammation (swelling).

Mohs addl stage

Additional stages required for a Mohs micrographic surgery, a procedure that involves removing one layer of skin cancer at a time for immediate examination of cancer cells.

Mohs 1 stage h/n/hf/g

Mohs micrographic surgery, a procedure that involves removing one layer of skin cancer at a time for immediate examination of cancer cells.

Tissue exam by pathologist

Interpretation of results from a pathologist tissue exam.

Shave skin lesion 0.6-1.0 cm

Shaving of skin lesions (abnormalities) on the skin for cosmetic or treatment purposes under local anesthesia.

Examination of sample tissue by a pathologist to diagnose or rule out certain conditions.

Destruct b9 lesion 1-14

Destruction of 1 to 14 benign (non-cancerous) skin abnormalities other than skin tags or certain types of birthmarks.

Destruct premalg lesion

Destruction of a single precancerous skin lesion (abnormality) through laser surgery, electrosurgery, cryosurgery (freezing) or curettement (scraping).

Destruct premalg les 2-14

Destruction of 2-14 pre-cancerous skin lesions (abnormalities) through laser surgery, electrosurgery, cryosurgery (freezing) or curettement (scraping).

Endocrinology

Dxa bone density axial

Axial DEXA scan, a non-invasive imaging test that measures bone density in the axial skeleton, which includes, for example, the hips, pelvis and spine.

Dxa bone density/peripheral

Peripheral DEXA scan, a non-invasive imaging test that measures bone density in the lower arm, wrist, finger or heel using a portable DEXA machine.

Psa screening

A blood test used to screen for prostate cancer.

Inj. cosyntropin 0.25 mg

Injection of cosyntropin (brand name: Cortrosyn) to diagnose adrenal gland disorders.

Cont gluc mntr phys/qhp eqp

Continuous glucose monitoring, including sensor placement, patient training, calibration, removal and downloading data from the monitor.

Echo guide for biopsy

Use of ultrasound technology to guide the placement of a needle during a biopsy.

Us exam of head and neck

Use of ultrasound technology to examine salivary glands, lymph nodes, lesions and the endocrine system.

Cont gluc mntr analysis i&r

Analysis and interpretation of data from a continuous glucose monitor, a device that tracks your blood sugar.

Ceftriaxone sodium injection

Antibacterial injection used to treat infection.

Remove tonsils and adenoids

Surgical removal of tonsils and adenoids, a patch of tissue in the back of the throat.

Repair of nasal septum

A surgical procedure to correct a deviated septum, a condition in which the bone and cartilage that separates the nose is off center.

Create eardrum opening

Surgical opening of the eardrum and insertion of a ventilating tube, called a tympanostomy.

Control of nosebleed

Control of minor nosebleed that originates in the front of the nose (anterior).

Removal of tonsils

Surgical removal of tonsils.

Ear microscopy examination

Examination of the ear using a microscope.

Tympanometry

A test used to diagnose and monitor conditions of the middle ear.

Diagnostic laryngoscopy

Diagnostic examination of voice box using an endoscope, an instrument used to look inside the body.

Remove impacted ear wax uni

Removal of earwax buildup.

Family Medicine

Dexamethasone sodium phos

Injection of dexamethasone, a steroid used to treat inflammation (swelling).

Ketorolac tromethamine inj

Injection of a nonsteroidal anti-inflammatory drug (NSAID) used for the short-term treatment of moderate to severe pain.

Synvisc or synvisc-one

An injection used to treat osteoarthritis pain.

Strep a assay w/optic

Strep test that detects the presence of streptococcus bacteria using a throat swab.

Denosumab injection

Injection of denosumab (brand names: Prolia and Xgeva) to treat osteoporosis and high calcium levels and prevent fractures.

Rbc sed rate nonautomated

Red blood cell sedimentation test, a blood test that detects inflammatory activity in the body.

Immunization admin each add

Administration of additional immunizations that do not involve face-to-face counseling.

Im admin each addl component

Administration of additional immunizations with physician counsel for patients age 18 and younger.

Im admin 1st/only component

Administration of initial immunization with physician counsel for patients age 18 and younger.

Ppps subseq visit

Subsequent Annual Wellness Visits, yearly follow-up appointments to discuss and adjust a patient's personalized prevention plan (initial appointment).

Ppps initial visit

Initial Annual Wellness Visit, the first yearly appointment to create a patient's personalized prevention plan.

Initial preventive exam

Welcome to Medicare visit, a one-time appointment for patients new to Medicare to cover health history and create a prevention plan.

Per pm reeval est pat 65+ yr

Established patient periodic preventive medicine examination in adults over age 65, including age- and gender-appropriate history and physical exam.

Prev visit est age 40-64

Established patient periodic preventive medicine examination in adults ages 40 to 64, including age- and gender-appropriate history and physical exam.

Prev visit est age 18-39

Established patient periodic preventive medicine examination in adults ages 18 to 39, including age- and gender-appropriate history and physical exam.

Init pm e/m new pat 65+ yrs

Initial new patient preventive medicine evaluation in adults over age 65, including age- and gender-appropriate history and physical exam.

Prev visit new age 40-64

New patient preventive medicine evaluation in adults ages 40 to 64, including age- and gender-appropriate history and physical exam.

Prev visit new age 18-39

New patient preventive medicine evaluation in adults ages 18 to 39, including age- and gender-appropriate history and physical exam.

Gastroenterology

Diagnostic colonoscopy

Diagnostic colonoscopy, a colonoscopy performed as the result of an abnormal test result, sign or symptom

Esoph egd dilation <30 mm

EGD with esophagus dilation, a procedure to widen a narrowed esophagus, which often occurs as the result of acid reflux.

Colonoscopy and biopsy

Colonoscopy with biopsy, a procedure used to examine the colon with the removal of tissues (biopsy) for testing.

Colonoscopy w/lesion removal

Colonoscopy with lesion removal, a procedure used to examine the colon with the removal of polyps, tumors or other lesions.

Egd biopsy single/multiple

EGD with biopsy, a procedure used to examine the esophagus, stomach and the upper part of the small intestine with the removal of tissues (biopsy) for testing.

Follow up evaluation and management of a patient in the hospital requiring high-complexity medical decision making (Level 3).

Colon ca scrn not hi rsk ind

Screening colonoscopy, a colonoscopy for a low-risk individual without symptoms to screen for colorectal cancer and check for the presence of polyps.

Initial evaluation of a patient in the hospital requiring moderately complex medical decision making and a comprehensive exam (Level 2).

Egd diagnostic brush wash

A procedure used to examine the esophagus, stomach and the upper part of the small intestine with specimen collection.

General Cardiology

Electrocardiogram complete

Routine electrocardiogram (ECG or EKG) with interpretation.

Prgrmg eval implantable dfb

Evaluation, testing and programming adjustment of defibrillator with physician analysis, review and report.

Pm device progr eval multi

Evaluation, testing and programming adjustment of pacemaker with physician analysis, review and report.

Upr/lxtr art stdy 3+ lvls

Ultrasound study of the veins in the arms and legs (3 levels).

Extremity study

Ultrasound study of the veins in the arms and legs to detect venous insufficiency or deep vein thrombosis (DVT).

Ht muscle image spect mult

Physician interpretation of results from a myocardial perfusion imaging (MPI) test, which analyzes how the heart muscle functions.

Cardiovascular stress test

A test that monitors how the heart reacts to physical stress, typically using a treadmill or bicycle.

Extracranial bilat study

Ultrasound scanning of blood flow in the extracranial arteries (outside the brain) on both sides of head and neck.

Tte w/doppler complete

A procedure called a transthoracic echocardiogram that uses high-frequency sound waves to evaluate blood flow through the heart.

Ecg monit/reprt up to 48 hrs

Electrocardiographic monitoring for 24 hours using a holter monitor (with physician review and interpretation).

General Orthopedics

Injectiononabotulinumtoxina

Botox injection to treat muscle stiffness/spasm and migraines.

Inj trigger point 1/2 muscl

Trigger point injection, a procedure used to treat muscle pain (one to two muscles).

Betamethasone acet&sod phosp

Injection of betamethasone (brand name: Celestone Soluspan) to treat inflammation (swelling) and arthritis.

Fluid removal in a small joint (e.g., fingers or toes) without the use of ultrasound technology.

X-ray exam of wrist

Complete X-ray examination of the wrist with a minimum of three views.

Njx aa&/strd tfrm epi l/s 1

Epidural injection into the spine using the guidance of imaging technology

Inj tendon sheath/ligament

Tendon sheath and ligament injection, a procedure used to treat pain, caused by inflammation (swelling) or disease, in the structures surrounding tendons and joints.

X-ray exam l-s spine 2/3 vws

X-ray examination of the lower spine with two or three views.

X-ray exam of ankle

Complete X-ray examination of the ankle with a minimum of three views.

X-ray exam hip uni 2-3 views

X-ray examination of the hip and pelvis with two or three views.

X-ray examination of the wrist with two views.

Euflexxa inj per dose

Injection of Euflexxa to treat osteoarthritis pain.

X-ray exam of finger(s)

X-ray examination of one or more fingers with a minimum of two views.

X-ray exam of knee 3

X-ray examination of the knee with three views.

X-ray exam of shoulder

Complete X-ray examination of the shoulder with a minimum of two views.

X-ray exam of foot

Complete X-ray examination of the foot with a minimum of three views.

X-ray exam knee 4 or more

Complete X-ray examination of the knee with four or more views.

Hematology-Medical Oncology

Epoetin alfa non-esrd

Injection of epoetin alfa (brand names: Procrit and Epogen) to treat anemia in patients chronic kidney disease (non-end stage).

Injection elotuzumab 1mg

Injection of elotuzumab (brand name: Empliciti) to treat multiple myeloma, a cancer in the blood cells.

Injection nivolumab

Injection of nivolumab (brand name: Opdivo) to treat melanoma (skin cancer).

Infliximab not biosimil 10mg

Injection of infliximab to treat Crohn's disease, ulcerative colitis, rheumatoid arthritis and other conditions.

Inj trastuzumab excl biosimi

Injection of trastuzumab (brand names: Herceptin, Herzuma, Ogivri, Ontruzant) to treat breast cancer.

Docetaxel injection

Injection of docetaxel (brand names: Docefrez and Taxotere) to treat a variety of cancers.

Fosaprepitant injection

Injection of fosaprepitant (brand name: Emend) to prevent nausea and vomiting caused by chemotherapy.

Natalizumab injection

Injection of natalizumab (brand name: Tysabri) to treat relapsing forms of MS (multiple sclerosis).

Azacitidine injection

Injection of azacitidine (brand name: Vidaza) to treat a group of blood and bone marrow disorders.

Iron sucrose injection

Injection of iron sucrose (brand name: Venofer) to treat iron deficiency in patients with chronic kidney disease.

Paclitaxel injection

Injection of paclitaxel (brand names: Nov-Onxol, Onxol, Paclitaxel Novaplus, Taxol) to treat advanced ovarian, breast and other cancers.

Injection vedolizumab

Injection of vedolizumab (brand name: Entyvio) to treat Crohn's disease and ulcerative colitis in patients that have not had success with other medicines.

Oxaliplatin

Injection of oxaliplatin (brand name: Eloxatin) to treat advanced colorectal cancer.

Injection pertuzumab 1 mg

Injection of pertuzumab (brand name: Perjeta) to treat breast cancer that has spread to other parts of the body.

Inj levoleucovorin nos 0.5mg

Injection of levoleucovorin (brand names: Fusilev and Khapzory) to prevent the harmful effects of a cancer medicine called methotrexate.

Inj filgrastim excl biosimil

Injection of filgrastim (brand name: Neupogen) to treat a lack of white blood cells caused by cancer, chemotherapy, bone marrow transplant and other conditions.

Inj ferric carboxymaltos 1mg

Injection of ferric carboxymaltose (brand name: Injectafer) to treat iron deficiency anemia.

Mri lower extremity w/o dye

MRI scan of the lower extremity (leg) without contrast material (a substance used to enhance visibility of the body's internal structures).

Ct head/brain w/o dye

CT scan of head or brain without contrast material (a substance used to enhance visibility of the body's internal structures).

Set radiation therapy field

Complex management of radiation therapy for three or more treatment areas.

Ct thorax dx c-

CT scan of the thorax (the chest area) without contrast material (a substance used to enhance visibility of the body's internal structures).

Mri brain stem w/o dye

MRI scan of the brain, including the brain stem, without contrast (a substance used to enhance visibility of the body's internal structures).

Ct abd & pelv 1/> regns

CT scan of the abdomen and pelvis before and after contrast (a substance used to enhance visibility of the body's internal structures).

Mri pelvis w/o dye

MRI scan of the pelvis without contrast material (a substance used to enhance visibility of the body's internal structures).

Ct lower extremity w/o dye

CT scan of the lower extremity (leg) without contrast material (a substance used to enhance visibility of the body's internal structures).

Ct abd & pelvis w/o contrast

CT scan of the abdomen and pelvis region without contrast material (a substance used to enhance visibility of the body's internal structures).

Mri chest spine w/o dye

MRI scan of the thoracic (chest area) of the spine without contrast material (a substance used to enhance visibility of the body's internal structures).

Ct thorax dx c+

CT scan of the thorax (the chest area) with contrast material (a substance used to enhance visibility of the body's internal structures).

Mri brain stem w/o & w/dye

MRI scan of the brain and brain stem before and after contrast (a substance used to enhance visibility of the body's internal structures).

Ct abd & pelv w/contrast

CT scan of the abdomen and pelvis region with contrast material (a substance used to enhance visibility of the body's internal structures).

Mri neck spine w/o dye

MRI scan of the neck and upper spine without contrast material (a substance used to enhance visibility of the body's internal structures).

Mri joint upr extrem w/o dye

MRI scan of joint in the body's upper extremities (i.e., shoulder, elbow, wrist, etc.) without contrast material (a substance used to enhance visibility of the body's internal structures).

Mri jnt of lwr extre w/o dye

MRI scan of joints in the body's lower extremities (i.e., hip, knee, ankle, foot, etc.) without contrast material (a substance used to enhance visibility of the body's internal structures).

Mri lumbar spine w/o dye

MRI scan of the lower spinal canal (lower back) without contrast material (a substance used to enhance visibility of the body's internal structures).

Internal Medicine

Iiv4 vaccine splt 0.5 ml im

Split virus influenza vaccine, a type of influenza (flu) vaccine designed to cause fewer reactions at the injection site (e.g., swelling, rash, etc.).

Nursing facility care init

Initial evaluation and management of a patient in a nursing facility requiring low-complexity medical decision making.

Measure blood oxygen level

Non-invasive overnight measurement of oxygen levels in the blood using an ear or finger device.

Polysom 6/>yrs cpap 4/> parm

Physician interpretation of a polysomnogram (sleep study) of patients age 6 and older with CPAP machine assistance.

Evaluate pt use of inhaler

The demonstration and/or evaluation of patient use of an inhaler.

Vitamin b12 injection

An Injection used to treat vitamin b-12 deficiency.

Medroxyprogesterone acetate

Depo-Provera injection, an injection used as a contraceptive (birth control) or to treat kidney cancer, endometrial cancer and pain caused by endometriosis.

A blood test that measures the amount of hemoglobin (a protein that carries oxygen from your lungs to the rest of your body).

Assay of parathormone

A blood test that measures the level of parathyroid hormone in the blood.

Assay of magnesium

A blood test that measures the amount of magnesium in the blood.

Urine pregnancy test

A laboratory test that evaluates the urine to look for signs of pregnancy.

Assay of total testosterone

A blood test that measures the amount of testosterone in the blood.

C-reactive protein

A blood test that helps identify inflammation in the body.

Iron binding test

A blood test that measures the blood's ability to attach itself to iron and transport it around the body.

Assay of ferritin

Ferritin test, a blood test that shows how much iron the body stores.

Capillary blood draw

Sampling a small amount of blood from a puncture on the finger (finger prick), heel or earlobe.

Assay of iron

A blood test that measures iron levels in the blood to help diagnose anemia or other conditions.

Ur albumin quantitative

A laboratory test that measures albumin levels, a protein found in the blood.

Lactate (ld) (ldh) enzyme

LDH test, a blood test that measures lactate dehydrogenase in the body to looks for signs of damage to tissues in the body.

Assay of psa total

PSA test, a blood test that is used to screen for prostate cancer by measuring total prostate specific antigen (PSA).

Metabolic panel total ca

Basic metabolic panel, a blood test that measures blood sugar levels, electrolyte and fluid balance, and kidney function.

Prothrombin time

Laboratory test that calculates the average time it takes for your blood to clot.

Vitamin b-12

A blood test that measures the amount of vitamin b-12 in the body.

Assay of urine creatinine

Creatinine urine test, a laboratory test that measures the amount of creatinine (a chemical waste product) in the urine.

General health panel

A blood test that includes a complete blood count, a comprehensive metabolic panel and thyroid test.

Vitamin d 25 hydroxy

A blood test that measures the amount of vitamin D in the body.

Urinalysis auto w/o scope

Analysis of urine sample to diagnose UTIs, kidney disorders, liver problems, etc.

Glycosylated hemoglobin test

A1c test, a blood test that measures glycosylated hemoglobin; used to diagnose and monitor diabetes.

Assay of free thyroxine

Free T4 test, a blood test that is used to help diagnose conditions of the thyroid.

Assay thyroid stim hormone

TSH test, a blood test that measures the amount of thyroid-stimulating hormone (TSH) in the blood.

Lipid panel

A blood test that measures good and bad cholesterol and triglycerides (a type of fat in the blood).

Comprehen metabolic panel

A comprehensive panel that includes 14 blood tests, used for medical screening.

Complete cbc w/auto diff wbc

Complete blood count, A blood test used to evaluate overall health.

Routine venipuncture

Insertion of needle into vein for collection of blood samples.

Iiv adjuvant vaccine im

Inactivated influenza (flu) vaccine, a vaccine made from killed flu viruses.

Esrd svc pr day pt 20+

Dialysis services per day (for less than full month service).

Esrd home pt serv p mo 20+

Monthly home dialysis services.

Esrd srv 2-3 vsts p mo 20+

Monthly services (two - three visits per month) for patients with end-stage renal disease, including dialysis.

Hemodialysis one evaluation

Hemodialysis with a single physician evaluation.

Esrd srv 4 visits p mo 20+

Monthly services (four or more visits per month) for patients with end-stage renal disease, including dialysis.

Musc test done w/n test comp

A test in which a needle is inserted directly into a muscle (needle EMG) and records the muscle's electrical activity.

Njx aa&/strd gr ocpl nrv

Occipital nerve block, an injection into the occipital nerves (located above the neck) to treat chronic headaches.

Nrv cndj test 13/> studies

13 or more nerve conduction studies, which are used to evaluate the function of motor and sensory nerves.

Chemodenerv musc migraine

Chemodenervation, an injection procedure for the purposes of treating chronic migraines.

Autonomic nrv syst funj test

A test that evaluates functions of the autonomic nervous system, which controls heart rate, body temperature, breathing rate, etc.

Tdap vaccine 7 yrs/> im

Tdap vaccine, a vaccine that prevents tetanus, diphtheria (bacterial infection of the nose and throat), and pertussis (whooping cough).

Iiv4 vacc no prsv 0.5 ml im

Split virus influenza vaccine, a type of preservative-free influenza (flu) vaccine designed to cause fewer reactions at the injection site (e.g., swelling, rash, etc.).

Ob us limited fetus(s)

Real-time ultrasound limited to the evaluation of the fetal heartbeat and position.

Remove intrauterine device

Removal of IUD, a small, contraceptive (birth control) device.

Obstetrical care

Routine care for pregnant women, including pre- and postpartum care and delivery.

Insert intrauterine device

Insertion of an IUD, a small, contraceptive (birth control) device, into the uterus.

Ob us follow-up per fetus

Follow-up ultrasound for re-evaluation of fetal size.

Us exam pelvic complete

Nonobstetric ultrasound of the pelvis (i.e., ultrasounds unrelated to pregnancy care)

Ob us detailed sngl fetus

Real-time ultrasound of the uterus for a single fetus with evaluation of fetal anatomical development.

Fetal non-stress test

A screening test used to evaluate fetal oxygen supply. movement and heart rate.

Ophthalmology

After cataract laser surgery

A surgical procedure to treat haze that develops behind the lens after cataract surgery.

Visual field examination(s)

An examination that measures the field of vision, including peripheral (side) vision, during daylight conditions.

Cmptr ophth img optic nerve

Diagnostic imaging scan of the optic nerve used to detect glaucoma.

Ophthalmic biometry

Biometry eye test, a test that measures the shape and size of the eye.

Xcapsl ctrc rmvl w/o ecp

Removal of cataract with the insertion of a prosthetic lens.

Eye exam establish patient

An eye and medical examination of a limited portion of the eye (does not include a complete visual examination).

Cptr ophth dx img post segmt

Diagnostic imaging scan of the retina used to detect disease and assess eye health.

Eye exam new patient

Comprehensive eye and medical examination for a new patient.

Eye exam&tx estab pt 1/>vst

Comprehensive eye and medical examination for an established patient.

Determine refractive state

Assessment of the eyes for prescription eyewear using a range of lens powers.

Prev visit est age 12-17

Established patient periodic preventive medicine examination in adolescents ages 12 to 17, including age- and gender-appropriate history and physical exam.

Prev visit est age 5-11

Established patient periodic preventive medicine examination in children ages 5 to 11, including age- and gender-appropriate history and physical exam.

Prev visit est age 1-4

Established patient periodic preventive medicine examination in children ages 1 to 4, including age- and gender-appropriate history and physical exam.

Per pm reeval est pat infant

Established patient periodic preventive medicine examination in an infant younger than 1 year, including age- and gender-appropriate history and physical exam.

Prev visit new age 12-17

New patient preventive medicine evaluation in adolescents ages 12 to 17, including age- and gender-appropriate history and physical exam.

Prev visit new age 5-11

New patient preventive medicine evaluation in children ages 5 to 11, including age- and gender-appropriate history and physical exam.

Init pm e/m new pat 1-4 yrs

Initial new patient preventive medicine evaluation in children ages 1 to 4, including age- and gender-appropriate history and physical exam.

Init pm e/m new pat infant

Initial new patient preventive medicine evaluation in an infant younger than 1 year, including age- and gender-appropriate history and physical exam.

Radiation Oncology

Radiology port images(s)

X-ray images taken throughout radiation treatment to check the positioning of the radiation.

Radiation treatment aid(s)

The design and construction of complex treatment devices that assist in radiation therapy.

Radiation physics consult

Consultation of radiation therapy including assessment of treatment and review of dose delivery.

Radiation tx management x5

Management of five courses of radiation treatment.

Radium ra223 dichloride ther

Injection of radium dichloride (brand name: Xofigo) to treat prostate cancer.

Radiation therapy dose plan

The measurement, calculation and assessment of radiation therapy doses.

Stereoscopic x-ray guidance

An imaging test that is used to identify the volume of radiation therapy needed.

Interpretation of results from a stereoscopic X-ray, an imaging test that is used to identify the volume of radiation therapy needed.

Radiation tx delivery imrt

IMRT (intensity modulated radiation therapy), a type of radiation therapy in which the intensity of the radiation beam is adapted to match the precise shape of a tumor and minimize tissue damage.

Radiation treatment delivery

The delivery of radiation treatment in three or more treatment areas.

Physician interpretation of the results from a CT scan of head or brain without contrast material (a substance used to enhance visibility of the body's internal structures).

Needle localization by xray

The use of imaging technology to ensure precise placement of a needle for biopsy, injections, aspirations (removal of cells and fluids via suction), etc.

Gad-base mr contrast nos1ml

Injection of a contrast agent (a substance used to enhance visibility of the body's internal structures) to improve the quality of MRI images.

Physician interpretation of the results from a CT scan of the abdomen and pelvis region without contrast material (a substance used to enhance visibility of the body's internal structures).

Echo exam of abdomen

Real-time ultrasound exam of the abdomen to diagnose medical conditions.

MRI scan of the lower spinal canal without contrast material (a substance used to enhance visibility of the body's internal structures).

Physician interpretation of the results from a CT scan of the abdomen and pelvis region with contrast material (a substance used to enhance visibility of the body's internal structures).

Breast tomosynthesis bi

Physician interpretation of the results from a mammogram, a test used to detect breast cancer.

Scr mammo bi incl cad

Physician interpretation of the results from a 3D mammogram, a test used to detect breast cancer.

Screening 3D mammogram, a test used to detect breast cancer in women using tomosynthesis, a method that produces high-definition, 3D images; often used in conjunction with a typical mammography.

Screening mammogram, a test used to detect breast cancer in women using radiographic (X-ray) technique.

Sleep Medicine

Polysom any age 1-3> param

A polysomnogram (sleep study) of patients of any age that tracks one to three measures of sleep.

Sleep study attended

A sleep study that also records breathing, heart rate and oxygen saturation, and is attended by a technologist.

Multiple sleep latency test

A test that measures alertness, how quickly you fall asleep and other measures of sleep to diagnose a sleep disorder.

Sleep study unatt&resp efft

A polysomnogram (sleep study) conducted at home instead of at a sleep center.

A polysomnogram (sleep study) of patients age 6 and older with CPAP machine assistance that tracks four or more measures of sleep.

Polysom 6/> yrs 4/> param

A polysomnogram (sleep study) of patients age 6 and older that tracks four or more measures of sleep.

Spine and Rehab

Pt eval mod complex 30 min

30-minute evaluation of physical therapy treatment for a patient with moderate complexity.

Ultrasound therapy

A procedure in which a physical therapist uses ultrasound technology to reduce pain.

Elec stim other than wound

Non-wound care electrical Stimulation (E-stim), a therapy in which electrodes are applied to the skin, sending electric pulses to the muscles for therapy other than wound care.

Electric stimulation therapy

A therapy in which electrodes are applied to the skin, sending electric pulses to the muscles (sometimes called E-stim)

Manual therapy 1/> regions

Therapeutic exercises in which a physical therapist manipulates and moves the muscles or joints.

Hot or cold packs therapy

Application of a hot or cold pack to one or more area.

Therapeutic exercises

Therapeutic physical therapy exercises in one or more areas.

Anl sp inf pmp w/mdreprg&fil

Electronic analysis, reprogramming and refill of implanted pump used for epidural drug infusion.

Neuromuscular reeducation

A therapeutic procedure to restore normal function of the nerves and muscles.

Nrv cndj test 9-10 studies

Nine to 10 nerve conduction studies, which are used to evaluate the function of motor and sensory nerves.

Abobotulinumtoxina

Injection of abobotulinumtoxinA (brand name: Dysport) to treat muscle spasms.

Mechanical traction therapy

A non-surgical procedure that treats lower back, neck, and radiating arm and leg pain.

Sports Fitness and Physical Therapy

Self care mngment training

Self-care and home management training for patients who need help with activities of daily living.

Aquatic therapy/exercises

Exercises performed in water for physical rehabilitation.

Whirlpool therapy

A therapy that decreases pain and swelling, promotes wound healing and increases mobility.

Pt eval low complex 20 min

20-minute evaluation of physical therapy treatment for a patient with low complexity.

Therapeutic activities

Physical therapy activities with direct, one-on-one patient contact.

Surgery Center

Knee arthroscopy/surgery

Minimally invasive knee surgery that involves shaving the meniscus and cartilage.

Revj reconstructed breast

Revision surgery after a breast reconstruction procedure

Sho arthrs srg decompression

A minimally invasive procedure of the shoulder to treat shoulder impingement.

Wrist endoscopy/surgery

Surgical release of wrist ligament using an endoscope.

Resect inferior turbinate

Turbinate reduction surgery, the partial or complete removal of the structures in your nose that cleans the air that passes through the nostrils into the lungs.

Urgent Care

Inj nalbuphine hydrochloride

An injection of nalbuphine hydrochloride (brand name: Nubain), which is a narcotic used to treat pain.

Rpr s/n/ax/gen/trnk 2.5cm/<

Treatment of a superficial (minor, occurring in the top layer of the skin) wound.

A device to immobilize (support and keep still) injured parts of the body such as fractures or dislocations.

Diphenhydramine hcl injectio

Injection of diphenhydramine (brand name: Benadryl) to treat anaphylaxis (a life-threatening allergic reaction).

Albuterol ipratrop non-comp

Nebulizer treatment, use of the medication albuterol ipratropium (brand name: DuoNeb) to treat wheezing and shortness of breath.

Promethazine hcl injection

Injection of promethazine (brand names: Antinaus 50, Phenergan, Promacot, Prorex) to relieve or prevent allergic reactions.

Airway inhalation treatment

A procedure to treat the obstruction of airways or collect specimens for testing.

Peng benzathine/procaine inj

Injection of penicillin to treat moderate to severe bacterial infections.

Ondansetron hcl injection

Injection of ondansetron (brand name: Zofran) to reduce nausea.

Fragmenting of kidney stone

A procedure that uses shock waves to break up kidney stones into small pieces that can pass through the body, called lithroscopy.

Urinary leg or abdomen bag

Urinary drainage bag, a bag attached to the leg or abdomen that collects urine through a catheter, a thin tube that drains urine from the bladder.

Cystoscopy and treatment

Examination of the bladder and urethra (cystoscopy) with the insertion of a stent, a tube that supports the urinary duct (ureter).

Electro-uroflowmetry first

Electronic assessment of urine flow.

Inj potassium chloride

Injection of potassium chloride used to treat low levels of potassium in the blood.

Collagenase clost hist inj

Injection of collagenase (brand name: Xiaflex) to treat Peyronie's disease.

Examination of the bladder and urethra using an endoscope, an instrument that allows a provider to look deep inside the body.

Us urine capacity measure

Measurement of bladder capacity (the maximum amount of urine the bladder can hold) using ultrasound technology.

Degarelix injection

Injection of degarelix (brand name: Firmagon) to treat advanced prostate cancer.

Wellness Center

Medical nutrition indiv in

Initial assessment and development of a medical nutrition therapy plan (used to manage chronic conditions through an individual nutrition plan).

Med nutrition indiv subseq

Reassessment of a medical nutrition therapy plan (used to manage chronic conditions through an individual nutrition plan).

Code Description

Explanation

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Preventive Care Visit for Adult, Ages 18-39

A preventive (well-patient), outpatient office visit for an established patient, ages 18-39 years old.

Related Procedures

Related procedures are health care services that often occur during the same day as this lead procedure.

Administration of vaccine (90471)
Pap test, automated thin layer preparation; automated system and manual rescreening (88175)
Insertion of needle into vein for collection of blood sample (36415)
Detection test by nucleic acid for chlamydia trachomatis, amplified probe technique (87491)
Detection test by nucleic acid for neisseria gonorrhoeae (gonorrhoeae bacteria), amplified probe technique (87591)
Detection test by nucleic acid for human papillomavirus (hpv), high-risk types (87624)
Blood test, lipids (cholesterol and triglycerides) (80061)
Influenza vaccine, quadrivalent, preservative free, 0.5 ml dosage (90686)
Diphtheria, tetanus, and acellular pertussis vaccine (7 years or older) (90715)
Assessment of emotional or behavioral problems (96127)

Cost Data Source

This website is for informational purposes only. NHID has made every effort to provide accurate information. Cost estimates for medical and dental procedures are based on typical payments and do not represent what your bill will be. Consult with your provider and insurer to get a personalized estimate.

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IMAGES

99393 PREV VISIT, EST, AG
HEMOGLOBIN PT-FOCUSED HLTH RISK ASSMT $30 00 $30,00 CAPILLARY BLOOD
PPT
What is a level 4 office / outpatient visit in medical coding? 99214
Provider Description Billed VISUAL ACUITY SCREEN HEMOGLOBIN PT-FOCUSED
Anticipatory guidance

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COMMENTS

Documenting and Coding Preventive Visits: A Physician's ...
The visits we considered were a 40-year-old established-patient preventive visit (CPT 99396), minus immunizations and other separate charges, and a level-4, established-patient, problem-oriented ...
CPT CODE 99391, 99395, 99396, 99397, 99394
CPT CODE AND Description. 99391 - 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; infant (age younger than 1 year) - Average fee amount $90
Making Sense of Preventive Medicine Coding
KEY POINTS. Preventive medicine coding varies based on the type of visit - a standard preventive E/M visit, a preventive E/M visit with a problem-oriented service, a preventive visit for a ...
Recommended Ways to Document and Report a Preventive Visit
Periodic comprehensive preventive medicine reevaluation and management, established patient; infant (age younger than 1 year) 99392 early childhood (age 1 through 4 years) 99393 late childhood (age 5 through 11 years) 99394 adolescent (age 12 through 17 years) 99395 18-39 years: 99396 40-64 years: 99397
Top 10 preventive medicine CPT codes
The top preventive medicine CPT code was 99396, a preventive visit for an established patient between ages 40 and 64, representing over 20% of all preventive medicine claims and nearly a quarter of total charges in 2022. The 40-64 age group is particularly susceptible to conditions like breast cancer, colon cancer, and osteoporosis.
Preventive Medicine Services Reporting
Codes 99381-99397 are used to report the preventive evaluation and management (E/M) of infants, children, adolescents, and adults. The extent and focus of the services will largely depend on the age of the patient. For example, E/M preventive services for a 28-year-old adult female may include a pelvic examination including obtaining a pap ...
CPT® Code
Established Patient CPT ® Code range 99391- 99397. The Current Procedural Terminology (CPT) code range for Preventive Medicine Services 99391-99397 is a medical code set maintained by the American Medical Association. ... Documenting chronic health problems with a comprehensive Preventive medicine visit.
Preventive Visit Coverage
This visit includes a review of your medical and social history related to your health. It also includes education and counseling about preventive services, including these: Certain screenings, flu and pneumococcal shots, and referrals for other care, if needed. Height, weight, and blood pressure measurements.
CPT CODE 99381, 99382
New versus Established client: A new client is defined as one who has not received any professional services from a physician/qualified health care professional in your health department, within the last three years, for a billable visit that includes some level of evaluation and management (E/M) service coded as a preventive service using ...
CPT Code 99396: Preventive Visit for New Patients 40-64
Preventive visit, new patient, 40-64 years CPT code 99396 signifies a comprehensive preventive medicine evaluation and management service for established patients. In the realm of preventive medicine services, this code is applied when healthcare providers engage in the in-depth assessment and management of established patients during ...
PDF DOCUMENTING AND CODING PREVENTIVE VISITS: A Physician's ...
established-patient preventive visit (CPT 99396), minus immunizations and other sepa-rate charges, and a level-4, established-patient, problem-oriented visit (CPT 99214). We
Preventive visit, established patient, 40-64 years
Preventive visit, established patient, 40-64 years CPT code 99386 signifies a comprehensive preventive medicine evaluation and management service for new patients. In the realm of preventive medicine services, this code is applied when healthcare providers engage in the in-depth assessment and management of new patients during preventive care ...
Preventive visit, established patient, 18-39 years
Preventive visit, established patient, 18-39 years. Comprehensive preventive medicine services are crucial for maintaining patient health, demanding precise coding to reflect the thorough nature of patient encounters. CPT code 99385 designates a comprehensive preventive medicine evaluation and management service for new patients, emphasizing ...
PDF Basic E&M Coding
Preventive Visit Codes Age based, New vs Established Patient Established Patient New Patient 99391 < 1 year 99381 99392 1 -4 years 99382 99393 5 -11 years 99383 ... Sometimes a patient has a Preventive Visit but also has a problem oriented issue as well, either acute or chronic. These issues are separate from the Preventive Service visit ...
Combining a Wellness Visit With a Problem-Oriented Visit: a ...
Codes 99381-99387 are for new patients and 99391-99397 are for established patients. ... If a patient comes in for a preventive visit and the clinician also looks at a rash or notices the patient ...
PDF Helping you to code more efficiently and effectively
G0438 and G0439 are Annual Wellness Visits, abbreviated AWV (I for initial, S for subsequent), and can be coded IN ADDITION to a problem-based E&M visit. PR PREVENTIVE VISIT(s) are physicals, which private insurers including Medicare Advantage cover - and generally pay as much or more than a high-level E&M visit. Suggested adds to Charge ...
Is it a Preventive Visit or an Office Visit?
Can Office and Preventive Visits be Billed Together? The short answer is yes. CPT® codes 99381-99397 are used for comprehensive preventive evaluations that are age-specific, beginning with infancy and ranging through patients 65 years and older, for both new and established patients. According to CPT® guidelines, for codes 99381-99397, code ...
500 Items and Services
Periodic primary re-evaluation for an established infant patient: 99392: PREV VISIT EST AGE 1-4: Initial visit for new patients 1-4 years old: 99393: PREV VISIT EST AGE 5-11: New preventative visit in new patients 5-11 years old: 99394: PREV VISIT EST AGE 12-17: New preventative visit in new patients 12-17 years old: 99395: PREV VISIT EST AGE 18-39
IHA Refence Guide for PCPs
99396 adult preventive visit est pt 40-64 yrs 99397 adult preventive visit est pt 65+ yrs 99461 1st care pr day nml nb xcpt hosp/birthing cntr z00.00 encntr adult medical exam w/o abnrml fndgs z00.01 encntr adult medical exam w/ abnrml fndgs z00.8 encntr for other general examination z00.121 ...
Procedure Pricing
Prev visit est age 12-17. Established patient periodic preventive medicine examination in adolescents ages 12 to 17, including age- and gender-appropriate history and physical exam. $189. 99393. Prev visit est age 5-11.
Wiki Fee schedule for Preventive visits
99392 N + Prev visit est age 1-4 1.50 1.42 0.58 0.09 3.01 2.17 99393 N + Prev visit est age 5-11 1.50 1.41 0.58 0.09 3.00 2.17 99394 N + Prev visit est age 12-17 1.70 1.49 0.66 0.10 3.29 2.46 99395 N + Prev visit est age 18-39 1.75 1.51 0.68 0.10 3.36 2.53 99396 N + Prev visit est age 40-64 1.90 1.57 0.73 0.11 3.58 2.74 ...
Preventive Care Visit for Adult, Ages 18-39
A preventive (well-patient), outpatient office visit for an established patient, ages 18-39 years old. This is an estimate of the total charge for the health care service before any discounts provided to the uninsured. Sort by Estimate of Procedure Cost. The minimum discount rate that the health care provider gives to the New Hampshire ...
CPT® Code 99395
Summary. The provider performs an established well-patient visit for a patient who is between the ages of 18 and 39. For clinical responsibility, terminology, tips and additional info start codify free trial.

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CPT CODE 99381, 99382 – 99385 – Preventive visit new patient

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Preventive Care Visit for Adult, Ages 18-39

Related Procedures

Cost Data Source

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