What does CPT code 99397 mean?
CPT® Code 99397 - Established Patient Preventive Medicine Services - Codify by AAPC.
Physical Exam CPT Codes For New Patients
CPT 99381: New patient annual preventive exam (younger than 1 year). CPT 99382: New patient annual preventive exam (1-4 years). CPT 99383: New patient annual preventive exam (5-11 years). CPT 99384: New patient annual preventive exam (12-17 years).
99395- 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; 18-39 years.
No you cannot bill the AWV with the preventive visit. You can bill the AWV with a separate E/M.
*The Annual Preventive Exam (99397) cannot be billed with the AWV or Welcome to Medicare Visit Can be billed as stand-alone: 99381-99387, 99391-99397 None. None. None. Once in a lifetime.
A full physical 99397 or 99387 is NOT covered by Medicare and patients are responsible for the cost and can be billed. Some secondary insurance companies may cover the full physical exam, which helps beneficiaries.
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For example:
- Female: breast exam, pelvic exam including Pap smear.
- Male: testicular, hernia and prostate exam.
- Child: well-child exam.
Physicians are not prohibited from coding and billing for both preventive and problem-focused E/M services when they are performed during the same appointment.
Well Women Exam CPT Code
CPT G0101 may be used to report Well Woman Exam. The description of the CPT code for Well woman is as follows: “Cervical or vaginal cancer screening; pelvic and clinical breast exam.”
When a preventative exam is performed, 99381-99397 and a person gets an immunization/hearing test/eye exam/etc... then a modifier 25 is put on the preventative exam code.
What is not covered in Medicare Annual Wellness visit?
The annual wellness visit generally doesn't include a physical exam, except to check routine measurements such as height, weight and blood pressure." The UNC School of Medicine notes, "Medicare wellness visits … are designed to improve your overall health care by providing a more detailed look at your health risks ...
CPT G0439 is used to code all subsequent Annual Wellness Visits that occur after the initial Annual Wellness Visit (G0438).
CPT® Code 99411 in section: Preventive medicine counseling and/or risk factor reduction intervention(s) provided to individuals in a group setting (separate procedure)
Physicians are not prohibited from coding and billing for both preventive and problem-focused E/M services when they are performed during the same appointment.
The two CPT codes used to report AWV services are: G0438 initial visit. G0439 subsequent visit.
For example, the time element of code 99401, “Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15 minutes,” is met when the physician spends at least eight minutes of face-to-face time counseling the patient.