Preventive Service Codes
The annual preventive exam is a periodic, comprehensive preventive medicine evaluation (or reevaluation) and management of the patient.
The CPT Code selection is based on whether the patient is receiving an initial visit -"New Patient" or a periodic - "Established Patient" preventive service, as well as the patient’s age.
- Initial Visits - 99381, 99382, 99383, 99384, 99385, 99386, 99387
- Subsequent Visits - 99391, 99392, 99393, 99394, 99395, 99396, 99397
- Welcome to Medicare - G0402 (Within the one year from the patient enrolled in Medicare)
- Initial Annual Wellness Visit - G0438 (After the 1st year of enrollment)
- Subsequent Annual Wellness Visit - G0439
Initial Visits
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,
- 99381 - Infant (age younger than 1 year)
- 99382 - Early childhood (age 1 through 4 years)
- 99383 - Late childhood (age 5 through 11 years)
- 99384 - Adolescent (age 12 through 17 years)
- 99385 - 18-39 years
- 99386 - 40-64 years
- 99387 - 65 years and older
Subsequent Visits
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,
- 99391 - 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 - 65 years and older
Included Services
Checking the status of "chronic conditions" and "refilling ongoing prescriptions" is expected during an annual preventive exam and does not warrant the billing of a separate problem-oriented E/M service.
If a chronic condition is not being well controlled, however, and decisions are being made as to how to treat the patient to improve control (changing the dosage of medications, changing to a new medication, etc.), this may substantiate a separate problem-oriented E/M service.
Documentation
- Medical and family history
- List of current medical providers
- Height, weight, BMI, BP, and other appropriate routine measurements
- Detection of cognitive impairment
- Review risk factors – Review of functional ability
- Establish a written screening schedule for the next 5-10 years
- Establish a list of risk factors
- Provide advice and referrals to health education and preventative counseling services
Tips - CPT G0402 & G0438 covered once in a lifetime for the patient.
See E/M 2021E&M guidelines
