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Annual Wellness Visit | CPT codes

2023 Annual Wellness Visit CPT Codes: G0402, G0438, G0439

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January 25th, 2023 | 7 min. read

2023 Annual Wellness Visit CPT Codes: G0402, G0438, G0439

ThoroughCare

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Understanding the billing codes for Medicare Annual Wellness Visits (AWVs) can provide a better idea of what is expected, both by the patient and by the payer. Understanding billing codes may also help you project revenues and optimize your staff’s capacity .

At ThoroughCare , we’ve worked with clinics and physician practices nationwide to help them streamline and capture Medicare reimbursements. Our software solution assists with the rules and regulations for AWVs while also tracking all activities related to providing the program and easing the difficulties of billing.

What are Annual Wellness Visits?

Annual Wellness Visits are free for anyone covered by Medicare Part B and include a yearly assessment of a patient’s health and overall well-being. They are designed not as a yearly physical examination, but as a critical care marker that bridges gaps in the yearly physical exam while developing and updating a patient’s personalized plan of care.

That personalized care plan is designed to help prevent disease and disability and is based on the patient’s current health and determined risk factors. The overall goal is to establish a record of the patient’s physical and mental well-being for the purpose of preventive health planning .

AWVs Include:

  • A health risk assessment (HRA)
  • A review and update of medical and family history
  • A review of current providers, prescriptions/medications, and durable medical equipment suppliers
  • Height, weight, blood pressure, BMI, and other routine measurements
  • Personalized health advice, health education, and preventative counseling
  • A list of identified risk factors, current medical and mental health conditions, and recommended treatment options
  • A cognitive impairment screening
  • A five to 10-year screening schedule for appropriate preventive services
  • A review of the patient’s functional ability and level of safety, including screening for hearing impairments, risk of falling, activities of daily living, and level of home safety
  • Identification of patients at risk for alcohol, tobacco, and opioid abuse
  • Advance care planning

There are three types of wellness visits : Initial Preventive Physical Examination (IPPE), an Initial Annual Wellness Visit, and the Subsequent Annual Wellness Visit. Each entails a different billing code as well as specific qualifiers for each program.

  • Initial Preventive Physical Examination: Patients may only receive this benefit within the first 12 months of their Medicare enrollment . Commonly referred to as the “welcome to Medicare visit,” it is considered a once in a lifetime assessment and after the initial eligibility period, the patient cannot receive an IPPE. It is also dependent on the HRA .
  • Initial Annual Wellness Visits : Similar to an IPPE, except it is available to a patient after 11 months of Medicare enrollment . This is for patients that miss their window for an IPPE. However, if the patient does complete an IPPE, they must still complete the Initial Annual Wellness Visit. This screening also includes an optional cognitive exam and end-of-life planning. 
  • Subsequent Annual Wellness Visit: Is the yearly follow-up to an Initial Annual Wellness Visit . Eleven full months after the Initial Annual Wellness Visit, a patient can attend these visits to modify and maintain their preventive care plan, based on how their health is at any given time. 

As the patient’s health evolves over time, a doctor may use the Subsequent Annual Wellness Visit to guide them toward other Medicare preventive programs, such as Chronic Care Management (CCM) , Behavioral Health Integration (BHI) , or Remote Patient Monitoring (RPM) . 

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Billing Medicare Annual Wellness Visits

Five items are required when submitting a claim through Centers for Medicare & Medicaid Services (CMS) :

  • A CPT Code for the specific type of AWV provided
  • An ICD-10 code for a general adult medical examination (Z00.00)
  • Date of service
  • Place of service (most office in-office or telehealth)
  • Submit National Provider Identifier (NPI) number

It is helpful to know the care manager assigned to a patient in case of an audit.

Three Steps to Bill for AWVs :

  • Verify CMS requirements were met
  • Submit claims to CMS annually
  • Determine there are no conflicting billing codes

CPT Codes for Annual Wellness Visits

See 2024 reimbursement rates here .

The types of AWVs are reflected in the CPT codes. The crucial qualifying determinant is when a certain AWV can be provided and billed.

awv_2023_cpt_codes_downloadable_cta (3)

AWVs for Federally Qualified Health Centers (FQHC) and Advance Care Planning (ACP)

As shown in the chart above, FQHC are able to bill for AWVs, although they utilize additional codes.

In addition to the standard CPT codes associated with AWVs, FQHC may use a special add-on code (G0468) that will allow them to receive additional reimbursement. For example, if an FQHC were to provide an IPPE, the clinic would bill for G0402 + G0468 for a total average reimbursement of $322. This coding indicates to CMS that the service is being provided through an FQHC. The good news is that these organizations receive much higher average reimbursement rates

Advance care planning (ACP) is not a type of AWV , but it can play a meaningful part in the program. 

ACP is a formal process to understand the patient’s preferences for potential and future medical care, such as end-of-life planning, a living will, and power of attorney. It is an opportunity to craft a patient-centered care plan and an AWV drives just that opportunity. Providers often complete an ACP during an AWV. 

ACP is fully covered for patients under Medicare Part B if it is conducted during the AWV. It is a free service that is an optional element of AWVs. Favorably, it is reimbursable for your practice and can be billed in concurrence with an AWV using CPT code 99497 for the first 30 minutes and 99498 for subsequent 30-minute billing.

Streamline Medicare Annual Wellness Visits

ThoroughCare   offers end-to-end workflow for Annual Wellness Visits.

We simplify the process and help providers engage patients to get their most relevant health information. Guided interviews help ask the right questions and ensure all service requirements are met. ThoroughCare includes digital solutions, such as:

  • An interactive health risk assessment
  • Screening tools, such as ADL, CAGE, DAST-10, GAD-7, MDQ, PAC, PHQ-2, and a mini cognitive exam
  • A care gaps summary with recommended interventions
  • A full report of Personalized Prevention Plan Services
  • Comprehensive care planning tools
  • Automated CPT code assignment for accurate billing

Request a Software Demo

Reimbursement rates are based on a national average and may vary depending on your location.   Check the Physician Fee Schedule   for the latest information.

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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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preventive visit cpt codes 2023

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preventive visit cpt codes 2023

Medicare Wellness Visits Back to MLN Print November 2023 Updates

preventive visit cpt codes 2023

What’s Changed?

  • Added information about monthly chronic pain management and treatment services
  • Added information about checking for cognitive impairment during annual wellness visits
  • Added information about Social Determinants of Health Risk Assessments as an optional element of annual wellness visits

preventive visit cpt codes 2023

Quick Start

The Annual Wellness Visits video helps you understand these exams, as well as their purpose and claim submission requirements.

Medicare Physical Exam Coverage

Initial Preventive Physical Exam (IPPE)

Review of medical and social health history and preventive services education.

✔ New Medicare patients within 12 months of starting Part B coverage

✔ Patients pay nothing (if provider accepts assignment)

Annual Wellness Visit (AWV)

Visit to develop or update a personalized prevention plan and perform a health risk assessment.

✔ Covered once every 12 months

Routine Physical Exam

Exam performed without relationship to treatment or diagnosis of a specific illness, symptom, complaint, or injury.

✘ Medicare doesn’t cover a routine physical

✘ Patients pay 100% out-of-pocket

Together we can advance health equity and help eliminate health disparities for all minority and underserved groups. Find resources and more from the CMS Office of Minority Health :

  • Health Equity Technical Assistance Program
  • Disparities Impact Statement

Communication Avoids Confusion

As a health care provider, you may recommend that patients get services more often than we cover or that we don’t cover. If this happens, help patients understand they may have to pay some or all costs. Communication is key to ensuring patients understand why you’re recommending certain services and whether we cover them.

preventive visit cpt codes 2023

Initial Preventive Physical Exam

The initial preventive physical exam (IPPE), also known as the “Welcome to Medicare” preventive visit, promotes good health through disease prevention and detection. We pay for 1 IPPE per lifetime if it’s provided within the first 12 months after the patient’s Part B coverage starts.

1. Review the patient’s medical and social history

At a minimum, collect this information:

  • Past medical and surgical history (illnesses, hospital stays, operations, allergies, injuries, and treatments)
  • Current medications, supplements, and other substances the person may be using
  • Family history (review the patient’s family and medical events, including hereditary conditions that place them at increased risk)
  • Physical activities
  • Social activities and engagement
  • Alcohol, tobacco, and illegal drug use history

Learn information about Medicare’s substance use disorder (SUD) services coverage .

2. Review the patient’s potential depression risk factors

Depression risk factors include:

  • Current or past experiences with depression
  • Other mood disorders

Select from various standardized screening tools designed for this purpose and recognized by national professional medical organizations. APA’s Depression Assessment Instruments has more information.

3. Review the patient’s functional ability and safety level

Use direct patient observation, appropriate screening questions, or standardized questionnaires recognized by national professional medical organizations to review, at a minimum, the patient’s:

  • Ability to perform activities of daily living (ADLs)
  • Hearing impairment
  • Home and community safety, including driving when appropriate

Medicare offers cognitive assessment and care plan services for patients who show signs of impairment.

  • Height, weight, body mass index (BMI) (or waist circumference, if appropriate), blood pressure, balance, and gait
  • Visual acuity screen
  • Other factors deemed appropriate based on medical and social history and current clinical standards

5. End-of-life planning, upon patient agreement

End-of-life planning is verbal or written information you (their physician or practitioner) can offer the patient about:

  • Their ability to prepare an advance directive in case an injury or illness prevents them from making their own health care decisions
  • If you agree to follow their advance directive
  • This includes psychiatric advance directives

6. Review current opioid prescriptions

For a patient with a current opioid prescription:

  • Review any potential opioid use disorder (OUD) risk factors
  • Evaluate their pain severity and current treatment plan
  • Provide information about non-opiod treatment options
  • Refer to a specialist, as appropriate

The HHS Pain Management Best Practices Inter-Agency Task Force Report has more information. Medicare now covers monthly chronic pain management and treatment services .

7. Screen for potential SUDs

Review the patient’s potential SUD risk factors, and as appropriate, refer them to treatment. You can use a screening tool, but it’s not required. The National Institute on Drug Abuse has screening and assessment tools. Implementing Drug and Alcohol Screening in Primary Care is a helpful resource .

8. Educate, counsel, and refer based on previous components

Based on the results of the review and evaluation services from the previous components, provide the patient with appropriate education, counseling, and referrals.

9. Educate, counsel, and refer for other preventive services

Include a brief written plan, like a checklist, for the patient to get:

  • A once-in-a-lifetime screening electrocardiogram (ECG), as appropriate
  • Appropriate screenings and other covered preventive services

Use these HCPCS codes to file IPPE and ECG screening claims:

Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment

Electrocardiogram, routine ecg with 12 leads; performed as a screening for the initial preventive physical examination with interpretation and report

Electrocardiogram, routine ecg with 12 leads; tracing only, without interpretation and report, performed as a screening for the initial preventive physical examination

Electrocardiogram, routine ecg with 12 leads; interpretation and report only, performed as a screening for the initial preventive physical examination

Federally qualified health center (fqhc) visit, ippe or awv; a fqhc visit that includes an initial preventive physical examination (ippe) or annual wellness visit (awv) and includes a typical bundle of medicare-covered services that would be furnished per diem to a patient receiving an ippe or awv

* Section 60.2 of the Medicare Claims Processing Manual, Chapter 9 has more information on how to bill HCPCS code G0468.

Report a diagnosis code when submitting IPPE claims. We don’t require you to use a specific IPPE diagnosis code, so you may choose any diagnosis code consistent with the patient’s exam.

Part B covers an IPPE when performed by a:

  • Physician (doctor of medicine or osteopathy)
  • Qualified non-physician practitioner (physician assistant, nurse practitioner, or certified clinical nurse specialist)

When you provide an IPPE and a significant, separately identifiable, medically necessary evaluation and management (E/M) service, we may pay for the additional service. Report the additional CPT code (99202–99205, 99211–99215) with modifier 25. That portion of the visit must be medically necessary and reasonable to treat the patient’s illness or injury or to improve the functioning of a malformed body part.

CPT only copyright 2022 American Medical Association. All rights reserved.

IPPE Resources

  • 42 CFR 410.16
  • Section 30.6.1.1 of the Medicare Claims Processing Manual, Chapter 12
  • Section 80 of the Medicare Claims Processing Manual, Chapter 18
  • U.S. Preventive Services Task Force Recommendations

No. The IPPE isn’t a routine physical that some patients may get periodically from their physician or other qualified non-physician practitioner (NPP). The IPPE is an introduction to Medicare and covered benefits, and it focuses on health promotion, disease prevention, and detection to help patients stay well. We encourage providers to inform patients about the AWV during their IPPE. The Social Security Act explicitly prohibits Medicare coverage of routine physical exams.

No. The IPPE and AWV don’t include clinical lab tests, but you may make appropriate referrals for these tests as part of the IPPE or AWV.

No. We waive the coinsurance, copayment, and Part B deductible for the IPPE (HCPCS code G0402). Neither is waived for the screening electrocardiogram (ECG) (HCPCS codes G0403, G0404, or G0405).

A patient who hasn’t had an IPPE and whose Part B enrollment began in 2023 can get an IPPE in 2024 if it’s within 12 months of the patient’s Part B enrollment effective date.

We suggest providers check with their MAC for available options to verify patient eligibility. If you have questions, find your MAC’s website .

Annual Wellness Visit Health Risk Assessment

The annual wellness visit (AWV) includes a health risk assessment (HRA). View the HRA minimum elements summary below. A Framework for Patient-Centered Health Risk Assessments has more information, including a sample HRA.

Perform an HRA

  • You or the patient can update the HRA before or during the AWV
  • Consider the best way to communicate with underserved populations, people who speak different languages, people with varying health literacy, and people with disabilities
  • Demographic data
  • Health status self-assessment
  • Psychosocial risks, including, but not limited to, depression, life satisfaction, stress, anger, loneliness or social isolation, pain, suicidality, and fatigue
  • Behavioral risks, including, but not limited to, tobacco use, physical activity, nutrition and oral health, alcohol consumption, sexual health, motor vehicle safety (for example, seat belt use), and home safety
  • Activities of daily living (ADLs), including dressing, feeding, toileting, and grooming; physical ambulation, including balance or fall risks and bathing; and instrumental ADLs (IADLs), including using the phone, housekeeping, laundry, transportation, shopping, managing medications, and handling finances

1. Establish the patient’s medical and family history

At a minimum, document:

  • Medical events of the patient’s parents, siblings, and children, including hereditary conditions that place them at increased risk
  • Use of, or exposure to, medications, supplements, and other substances the person may be using

2. Establish a current providers and suppliers list

Include current patient providers and suppliers that regularly provide medical care, including behavioral health care.

  • Height, weight, body mass index (BMI) (or waist circumference, if appropriate), and blood pressure
  • Other routine measurements deemed appropriate based on medical and family history

4. Detect any cognitive impairments the patient may have

Check for cognitive impairment as part of the first AWV.

Assess cognitive function by direct observation or reported observations from the patient, family, friends, caregivers, and others. Consider using brief cognitive tests, health disparities, chronic conditions, and other factors that contribute to increased cognitive impairment risk. Alzheimer’s and Related Dementia Resources for Professionals has more information.

5. Review the patient’s potential depression risk factors

6. Review the patient’s functional ability and level of safety

  • Ability to perform ADLs

7. Establish an appropriate patient written screening schedule

Base the written screening schedule on the:

  • Checklist for the next 5–10 years
  • United States Preventive Services Task Force and Advisory Committee on Immunization Practices (ACIP) recommendations
  • Patient’s HRA, health status and screening history, and age-appropriate preventive services we cover

8. Establish the patient’s list of risk factors and conditions

  • A recommendation for primary, secondary, or tertiary interventions or report whether they’re underway
  • Mental health conditions, including depression, substance use disorders , suicidality, and cognitive impairments
  • IPPE risk factors or identified conditions
  • Treatment options and associated risks and benefits

9. Provide personalized patient health advice and appropriate referrals to health education or preventive counseling services or programs

Include referrals to educational and counseling services or programs aimed at:

  • Fall prevention
  • Physical activity
  • Tobacco-use cessation
  • Social engagement
  • Weight loss

10. Provide advance care planning (ACP) services at the patient’s discretion

ACP is a discussion between you and the patient about:

  • Preparing an advance directive in case an injury or illness prevents them from making their own health care decisions
  • Future care decisions they might need or want to make
  • How they can let others know about their care preferences
  • Caregiver identification
  • Advance directive elements, which may involve completing standard forms

Advance directive is a general term that refers to various documents, like a living will, instruction directive, health care proxy, psychiatric advance directive, or health care power of attorney. It’s a document that appoints an agent or records a person’s wishes about their medical treatment at a future time when the individual can’t communicate for themselves. The Advance Care Planning fact sheet has more information.

We don’t limit how many times the patient can revisit the ACP during the year, but cost sharing applies outside the AWV.

11. Review current opioid prescriptions

  • Review any potential OUD risk factors
  • Provide information about non-opioid treatment options

12. Screen for potential SUDs

Review the patient’s potential SUD risk factors, and as appropriate, refer them for treatment. You can use a screening tool, but it’s not required. The National Institute on Drug Abuse has screening and assessment tools. Implementing Drug and Alcohol Screening in Primary Care is a helpful resource .

13. Social Determinants of Health (SDOH) Risk Assessment

Starting in 2024, Medicare includes an optional SDOH Risk Assessment as part of the AWV. This assessment must follow standardized, evidence-based practices and ensure communication aligns with the patient’s educational, developmental, and health literacy level, as well as being culturally and linguistically appropriate.

1. Review and update the HRA

2. Update the patient’s medical and family history

At a minimum, document updates to:

3. Update current providers and suppliers list

Include current patient providers and suppliers that regularly provide medical care, including those added because of the first AWV personalized prevention plan services (PPPS), and any behavioral health providers.

  • Weight (or waist circumference, if appropriate) and blood pressure

5. Detect any cognitive impairments patients may have

Check for cognitive impairment as part of the subsequent AWV.

6. Update the patient’s written screening schedule

Base written screening schedule on the:

7. Update the patient’s list of risk factors and conditions

  • Mental health conditions, including depression, substance use disorders , and cognitive impairments
  • Risk factors or identified conditions

8. As necessary, provide and update patient PPPS, including personalized health advice and appropriate referrals to health education or preventive counseling services or programs

9. Provide advance care planning (ACP) services at the patient’s discretion

10. Review current opioid prescriptions

11. Screen for potential substance use disorders (SUDs)

12. Social Determinants of Health (SDOH) Risk Assessment

Preparing Eligible Patients for their AWV

Help eligible patients prepare for their AWV by encouraging them to bring this information to their appointment:

  • Medical records, including immunization records
  • Detailed family health history
  • Full list of medications and supplements, including calcium and vitamins, and how often and how much of each they take
  • Full list of current providers and suppliers involved in their care, including community-based providers (for example, personal care, adult day care, and home-delivered meals), and behavioral health specialists

Use these HCPCS codes to file AWV claims:

Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit

Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit

Report a diagnosis code when submitting AWV claims. We don’t require you to use a specific AWV diagnosis code, so you may choose any diagnosis code consistent with the patient’s exam.

Part B covers an AWV if performed by a:

  • Medical professional (including health educator, registered dietitian, nutrition professional, or other licensed practitioner) or a team of medical professionals directly supervised by a physician

When you provide an AWV and a significant, separately identifiable, medically necessary evaluation and management (E/M) service, we may pay for the additional service. Report the additional CPT code (99202–99205, 99211–99215) with modifier 25. That portion of the visit must be medically necessary and reasonable to treat the patient’s illness or injury or to improve the functioning of a malformed body part.

You can only bill G0438 or G0439 once in a 12-month period. G0438 is for the first AWV, and G0439 is for subsequent AWVs. Don’t bill G0438 or G0439 within 12 months of a previous G0402 (IPPE) billing for the same patient. We deny these claims with messages indicating the patient reached the benefit maximum for the time period.

Medicare telehealth includes HCPCS codes G0438 and G0439.

ACP is the face-to-face conversation between a physician (or other qualified health care professional) and a patient to discuss their health care wishes and medical treatment preferences if they become unable to communicate or make decisions about their care. At the patient’s discretion, you can provide the ACP during the AWV.

Use these CPT codes to file ACP claims as an optional AWV element:

Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; first 30 minutes, face-to-face with the patient, family member(s), and/or surrogate

Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; each additional 30 minutes (List separately in addition to code for primary procedure)

Report a diagnosis code when submitting an ACP claim as an optional AWV element. We don’t require you to use a specific ACP diagnosis code as an optional AWV element, so you may choose any diagnosis code consistent with a patient’s exam.

We waive both the Part B ACP coinsurance and deductible when it’s:

  • Provided on the same day as the covered AWV
  • Provided by the same provider as the covered AWV
  • Billed with modifier 33 (Preventive Service)
  • Billed on the same claim as the AWV

We waive the ACP deductible and coinsurance once per year when billed with the AWV. If we deny the AWV billed with ACP for exceeding the once-per-year limit, we’ll apply the ACP deductible and coinsurance .

We apply the deductible and coinsurance when you deliver the ACP outside the covered AWV. There are no limits on the number of times you can report ACP for a certain patient in a certain period. When billing this service multiple times, document changes in the patient’s health status or wishes about their end-of-life care.

SDOH is important in assessing patient histories; in assessing patient risk; and in guiding medical decision making, prevention, diagnosis, care, and treatment. In the CY 2024 Medicare Physician Fee Schedule final rule , we added a new SDOH Risk Assessment as an optional, additional element of the AWV. At both yours and the patient’s discretion, you may conduct the SDOH Risk Assessment during the AWV.

Use this HCPCS code to file SDOH Risk Assessment claims as an optional AWV element:

Administration of a standardized, evidence-based social determinants of health risk assessment tool, 5-15 minutes

Report a diagnosis code when submitting an SDOH Risk Assessment claim as an optional AWV element. We don’t require you to use a specific SDOH Risk Assessment diagnosis code as an optional AWV element, so you may choose any diagnosis code consistent with a patient’s exam.

The implementation date for SDOH Risk Assessment claims is July 1, 2024. We waive both the Part B SDOH Risk Assessment coinsurance and deductible when it’s:

We waive the SDOH Risk Assessment deductible and coinsurance once per year when billed with the AWV.

If we deny the AWV billed with SDOH Risk Assessment for exceeding the once-per-year limit, we’ll apply the deductible and coinsurance. We also apply the deductible and coinsurance when you deliver the SDOH Risk Assessment outside the covered AWV.

AWV Resources

  • 42 CFR 410.15
  • Section 140 of the Medicare Claims Processing Manual, Chapter 18

No. The AWV isn’t a routine physical some patients may get periodically from their physician or other qualified NPP. We don’t cover routine physical exams.

No. We waive the coinsurance, copayment, and Part B deductible for the AWV.

We cover an AWV for all patients who’ve had Medicare coverage for longer than 12 months after their first Part B eligibility date and who didn’t have an IPPE or AWV within those past 12 months. We cover only 1 IPPE per patient per lifetime and 1 additional AWV every 12 months after the date of the patient’s last AWV (or IPPE). Check eligibility to find when a patient is eligible for their next preventive service.

Generally, you may provide other medically necessary services on the same date as an AWV. The deductible and coinsurance or copayment applies for these other medically necessary and reasonable services.

You have different options for accessing AWV eligibility information depending on where you practice. Check eligibility to find when a patient is eligible for their next preventive service. Find your MAC’s website if you have specific patient eligibility questions.

Know the Differences

An IPPE is a review of a patient’s medical and social health history and includes education about other preventive services .

  • We cover 1 IPPE per lifetime for patients within the first 12 months after their Part B benefits eligibility date
  • We pay IPPE costs if the provider accepts assignment

An AWV is a review of a patient’s personalized prevention plan of services and includes a health risk assessment.

  • We cover an annual AWV for patients who aren’t within the first 12 months after their Part B benefits eligibility date
  • We cover an annual AWV 12 months after the last AWV’s (or IPPE’s) date of service
  • We pay AWV costs if the provider accepts assignment

A routine physical is an exam performed without relationship to treatment or diagnosis for a specific illness, symptom, complaint, or injury.

  • We don’t cover routine physical exams, but the IPPE, AWV, or other Medicare benefits cover some routine physical elements
  • Patients pay 100% out of pocket

View the Medicare Learning Network® Content Disclaimer and Department of Health & Human Services Disclosure .

The Medicare Learning Network®, MLN Connects®, and MLN Matters® are registered trademarks of the U.S. Department of Health & Human Services (HHS).

CPT codes, descriptions and other data only are copyright 2022 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

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It’s not hard, once you get the hang of it, but the differences from E/M coding can be confusing.

TIMOTHY OWOLABI, MD, CPC, AND ISAC SIMPSON, DO

Fam Pract Manag. 2012;19(4):12-16

Dr. Owolabi is a board-certified family physician and certified professional coder employed by Summit Physician Services, a multispecialty, hospital-owned group practice in Chambersburg, Pa. In addition to managing a busy patient panel, Dr. Owolabi independently offers coding consulting services and speaks and writes on coding topics. Dr. Simpson is a family medicine resident at Phoenix Baptist Hospital Family Medicine Residency in Phoenix, Ariz. Author disclosure: no relevant financial affiliations disclosed.

This is a corrected version of the article previously published.

preventive visit cpt codes 2023

In our experience, family physicians vary widely in their understanding of preventive care coding. Questions we’ve heard range from “What ICD-9 codes are appropriate with preventive care visits?” all the way down to “Preventive codes? What are preventive codes? I only use evaluation and management [E/M] codes.” No matter what your level of comfort (or discomfort) with coding preventive visits, we hope to offer information you’ll find useful. We will define the documentation components necessary to code preventive visits for patients 18 to 64 years old, review the appropriate ICD-9 and CPT codes and how to properly pair them, and discuss the proper use of modifier 25. We won’t cover the Medicare guidelines for preventive visits or how to code pediatric preventive visits. Coding resources for these visits are listed below.

Components of a preventive visit

Preventive visits, like many procedural services, are bundled services. Unlike documenting problem-oriented E/M office visits (99201–99215), which involves complicated coding guidelines, documenting preventive visits is more straightforward. The following components are needed:

A comprehensive history and physical exam findings;

A description of the status of chronic, stable problems that are not “significant enough to require additional work,” according to CPT;

Notes concerning the management of minor problems that do not require additional work;

Notes concerning age-appropriate counseling, screening labs, and tests;

Orders for vaccines appropriate for age and risk factors.

According to CPT, the comprehensive history that must be obtained as part of a preventive visit has no chief complaint or present illness as its focus. Rather, it requires a “comprehensive system review and comprehensive or interval past, family, and social history as well as a comprehensive assessment/history of pertinent risk factors.” The preventive comprehensive exam differs from a problem-oriented comprehensive exam because its components are based on age and risk factors rather than a presenting problem.

Some have attempted to use modifier 52 to denote reduced services when less than a comprehensive history and exam are performed during a preventive visit. This is inappropriate because modifier 52 applies to procedural services only. Preventive visits that do not satisfy the minimum requirements may be billed with the appropriate E/M office visit code.

When submitting a preventive visit CPT code, it is not appropriate to submit problem-oriented ICD-9 codes. Linking problem-oriented ICD-9 codes with preventive CPT codes may delay payment or result in a denied claim. See “ Acceptable codes for preventive care visits ” for the appropriate ICD-9 codes and the HCPCS and CPT codes with which to pair them.

Coverage of preventive visits varies by insurer, so it is important to be aware of the patient’s health plan. Most plans limit the frequency of the preventive visit to once a year, and not all tests are covered. Fecal occult blood tests, audiometry, Pap smear collection, and vaccines and their administration should be billed separately. Visual acuity testing is not separately reimbursed. Without a new or chronic-disease diagnosis, all labs and other tests ordered during a preventive visit are for screening purposes, and an ICD-9 code for screening should be assigned on the order form and claim.

Another service that has a preventive purpose is the preoperative clearance. Review of the details of this encounter is beyond the scope of this discussion, but it is worth mentioning that many private payers cover the preoperative clearance when billed by primary care physicians using consultation E/M codes (99241-99255).

ACCEPTABLE CODES FOR PREVENTIVE CARE VISITS

Preventive visits and the role of counseling.

Preventive visit codes 99381-99397 include “counseling/anticipatory guidance/risk factor reduction interventions,” according to CPT. However, when such counseling is provided as part of a separate problem-oriented encounter, it may be billed using preventive medicine codes 99401-99409. For example, if you provide significant counseling on smoking cessation during a visit for an ankle sprain, you could bill for the counseling in addition to submitting an E/M office visit code for the problem-oriented service. A synopsis of the counseling should be included in your documentation, and ICD-9 codes for preventive counseling should be paired with your CPT codes (see “ Acceptable codes for preventive counseling services ”). Such a visit requires the use of modifier 25.

ACCEPTABLE CODES FOR PREVENTIVE COUNSELING SERVICES

Modifier 25.

When providing a preventive visit with a problem-oriented E/M service or procedural service on the same day, including modifier 25 in your coding may enable you to be paid for both services. CPT says modifier 25 is appropriate when there is a “significant, separately identifiable evaluation and management service by the same physician on the same day.” Stated another way, if the second service requires enough additional work that it could stand on its own as an office visit, use modifier 25. Modifier 25 should usually be attached to the problem-oriented E/M code. However, if the second service is a procedure, such as removal of a skin lesion performed in conjunction with a preventive visit, the modifier should be attached to the preventive visit code because it is the E/M service.

Having a separate note for the second service can greatly decrease the likelihood of having it inappropriately bundled or denied. Note that no one item of documentation can count toward both services. A problem-oriented E/M service that requires a considerable amount of work and pertinent documentation may absorb so many of the elements that would otherwise count toward the preventive service that you don’t have a comprehensive history and exam for the preventive service. This is one reason some doctors provide two visits in these situations.

Bundling is more likely if the separate service can be considered age-appropriate, such as initiating treatment for acne. However, if a separate E/M note can be written for the problem, the CPT description of modifier 25 and the exclusions listed for the preventive visit CPT codes indicate that the separate service should not be bundled. See “ Appropriate use of modifier 25 during a preventive visit ” for examples of complaints that under some circumstances would be handled as part of a preventive visit, but under different circumstances may require additional work that should be billed separately using modifier 25.

Unfortunately, not all carriers pay for services billed with modifier 25. For example, Aetna did not reimburse at all for modifier 25 until 2006, when it changed its policy as part of a class action settlement with multiple state medical societies. The circumstances in which its use is permitted and the amount of payment for the separate service vary. The lack of consensus on the use of modifier 25 for preventive services places the onus on providers to learn the requirements of each of their payers.

APPROPRIATE USE OF MODIFIER 25 DURING A PREVENTIVE VISIT

Preventive care and productivity.

Discussing the cost-effectiveness of preventive visits for the practice is tricky because of the number of variables to consider. Time spent per preventive visit is a key confounding variable. Others include fee schedule variations between payers, payer mix, productivity variations between physicians, which preventive service is being considered (for patients in the 18–39 age group vs. those in the 40–64 age group or new vs. established), and accuracy of coding, to mention a few.

While the numerous variables make broad generalizations about the immediate cost-effectiveness of preventive visits extremely difficult, careful analysis may lead some practices to conclude that preventive care is beneficial not only for the patient but for the practice as well. As an example, we averaged payment for two visit types from nine actual payers. 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 visit (CPT 99214). We found the average payment for the preventive visit to be 25 percent higher than for the problem-oriented visit. That is, the preventive visit produces more revenue per unit of time unless the preventive visit takes at least 25 percent longer. Of course, if a preventive visit requires considerably more time than a comparable level-3 or level-4 E/M visit, replacing preventive visits with a larger number of problem-oriented visits could result in more reimbursement overall, at least in theory.

Role of preventive services in our health care system

Some researchers estimate that 75 percent of all health care costs are due directly to preventable chronic conditions, yet as recently as 2004, only 1 percent of money spent on health care in the United States was devoted to prevention. 1 , 2 We don’t wish to spark a debate on whether preventive services directly reduce health care costs, but we speculate that preventive care has the potential to play a more valuable role in our health care system than it does currently. The Centers for Medicare & Medicaid Services did not cover preventive care visits until the institution of the “Welcome to Medicare” visit in 2005. In contrast, many private payers have covered preventive visits for some time. Perhaps this is because they have long recognized that healthy lifestyle choices and routine health surveillance mitigate the risk of chronic disease.

PREVENTIVE VISIT ALGORITHM: PATIENTS AGES 18–64*

Regardless of insurance coverage, patients should at least be offered preventive services even if they must pay out of pocket for them. The “ Preventive visit algorithm ” illustrates how one might approach a preventive visit for a patient in the 18 to 64 age range (except for recommended pregnancy-related services). This schematic is not intended to reflect all the anticipatory guidance or all of the screening that you might recommend for a given patient, but rather includes suggestions based on the strongest evidence-based recommendations from the Centers for Disease Control and Prevention and the U.S. Preventive Services Task Force.

ADDITIONAL RESOURCES FOR CODING PREVENTIVE CARE

Coding for Pediatric Preventive Care 2012 . American Academy of Pediatrics.

What You Need to Know About the Medicare Preventive Services Expansion . FPM . Jan/Feb 2011.

Making Sense of Preventive Medicine Coding . FPM . Apr 2004.

Medicare Preventive Services: Quick Reference . Centers for Medicare & Medicaid Services.

Center for Medicare & Medicaid Services National Health Expenditures and Selected Economic Indicators, Levels and Average Annual Percent Change: Selected Calendar Years 1990–2013 Washington, DC: Center for Medicare & Medicaid Services, Office of the Actuary; 2004.

Institute of Medicine The Future of the Public’s Health in the 21st Century. Washington, DC: National Academy Press; 2002.

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March 6, 2024

Prevention and Screening

Prevention

Keeping patients healthy, providing advice about health risks and recommending screening tests and immunizations are the heart of primary care medicine. CPT uses one set of codes and Medicare another, and you’ll find coding information on both here, along with guidance on billing for split visits.

  • Coding Guide | Preventive Medicine Services
  • ROS requirements for preventive services OB/GYN
  • Billing for pap smear
  • Preventive Medicine Services | Medicare
  • Prolonged services codes for Medicare preventive medicine services: G0513, G0514
  • Age and wellness visits | Eligibility for Welcome to Medicare
  • G0101 Pelvic and Breast Exam
  • Wellness visits and care management in Rural Health Centers and Federally Qualified Health Centers (RHCs and FQHCs)
  • Coding and reimbursement for lactation services
  • Smoking cessation coding, 99406 and 99407

HCPCS Screening Codes

  • HCPCS Code G0136 for Screening for the Social Determinants of Health (SDoH)
  • Screening for depression | HCPCS code G0444
  • Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse | HCPCS Code G0442
  • Screening for Other Sexually Transmitted Illnesses (STI)
  • Behavioral counseling for obesity, HCPCS code G0447
  • Intensive behavioral counseling for cardiovascular disease, HCPCS code G0446
  • High Intensity Behavioral Counseling to Prevent Sexually Transmitted Illnesses
  • Screening codes guide: G0442, G0443, G0444, G0446, G0447
  • Billing Preventive Medicine Services and Problem Visit | Quick reference sheet
  • Reporting a problem-oriented visit on the same day as Welcome to Medicare (G0402) or Initial and Subsequent Wellness Visit (G0438, G0439)
  • Can we bill a new patient visit for preventive and E/M services on the same day?
  • Can I get paid for a problem oriented visit and wellness visit on the same day? | Video
  • Preventive Medicine, Wellness Visits and Problem-Oriented Visits | Webinar

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  • Preventive Medicine Services Coding Guidelines
  • Posted on April 6, 2023
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Preventive care, designed to prevent problems can aid in detecting or preventing significant diseases and health problems before they become major issues. Examples of preventative care include annual checkups, vaccinations, flu injections, and participation in specific screenings and exams. This type of preventive care is also referred to as routine care.

In diagnostic care, a physician searches for a specific condition. For instance, a radiologist may recommend a patient for follow-up mammography. This follow-up will determine if anything was discovered during the normal or preventative mammography. After the initial screening for preventative treatment, diagnostic mammography is not covered by insurance.

Let’s learn more about the preventive medicine coding guidelines for 2022. The post details CPT preventive codes.

CPT Preventive Codes

Comprehensive preventive medicine services include counseling, anticipatory guidance, and risk factor reduction strategies. They are typically distinct from disease-related diagnoses and entail a patient-specific history and physical examination.

CPT preventive codes include 99381-99387 and 99391-99397.

  • 99381-99387: CPT preventive codes for the preventive exam of new patient
  • 99391-99397: Codes for the preventive exam of an established patient.

During a preventive visit, an unexpected item is discovered, an old problem is resolved, and essential E/M, i.e., Evaluation and Management services, are provided. It is known as “E/M service in a single visit.”

The diagnosis codes for the preventive coding include the following:

  • 00: General medical checkup of an adult with no abnormal findings
  • 01: General medical checkup of an adult with abnormal findings
  • 110-Z00.129: Newborn, infant, and child health checkups
  • 411: Gynecological checkup with abnormal results
  • 419: Gynecological checkup without abnormal results
  • 011-Z30.9: Contraception management

Use the corresponding Z code from the list alongside the CPT preventive code as the primary diagnosis code. The next step is to arrange by the time all of the short-term, long-term, and health status concerns that the physician discussed and recorded throughout the examination. In addition to the Z codes, documenting and coding any new or existing conditions present at the annual preventive exam will not result in claim denial.

Suppose a new abnormal discovery or an existing problem is significant enough during a preventive exam to necessitate additional work. In that case, the appropriate CPT preventive code from 99202-99215 with modifier 25 should also be reported. Modifier 25 indicates that the work was performed due to a current issue. In this instance, the documentation from the provider describing the new or old finding must be distinguishable from the documentation from the preventive exam. The member may be required to pay copayments or split the cost of insurance to receive these additional services. It is improper to submit a separate fee for prescription refills or medical conditions that do not require further work.

Preventive Medicine Coding Guidelines 2022

Below are the important guiding points for preventing medicine coding:

  • Doctors use measurements such as height, weight, body mass index, head circumference, and blood pressure as part of preventive medicine. Additionally, they conduct age- and gender-appropriate tests and histories.
  • Since CPT preventive codes are not time-based, the duration of the patient’s visit should not be considered while selecting the correct code.
  • Suppose an illness is discovered or any pre-existing problem is addressed during a preventive medicine service that requires additional work. In that case, the appropriate CPT preventive code (99202-99215) should be reported in addition to the preventive CPT codes. Add modifier 25 to any outpatient code (e.g., 99392 and 99213 25).
  • No separate report is required for any sickness, abnormality, or condition discovered during the preventive medicine service deemed minor.
  • Immunization materials and administration, as well as supplementary investigations requiring laboratory, radiological, or other procedures or screening tests (such as for eyesight, development, or hearing), are recorded and reimbursed separately from the preventive medicine service code.

Preventive Medicine Coding Guidelines and Abnormal Findings

When an ICD-10 code, such as Z00.121, is assigned to an abnormal finding, it does not indicate that an additional E/M service is necessary or even permitted. Even if abnormal findings are minor and do not necessitate additional examination, the condition may be documented as a contributing factor. Abnormal findings include abnormal screening results, new acute conditions, and deteriorating chronic illnesses. Stable chronic conditions do not require an abnormal results code, even if they are being treated. Even if the screening was normal, you could relate it to a code for abnormal findings under ICD-10. The incorrect item will be labeled with the correct ICD-10 code to alert the payer.

Modifier 25

Extra billable services comprise independent, significant physician evaluation and management (E/M) work. It is often performed as part of preventive medicine treatment or small surgical procedures. Modifier 25 informs the insurance company that payment is required for both procedures. When utilized properly, it can generate more revenue.

Modifier-25 indicates that the assessment and management service was significant and distinguishable from a small procedure performed on the same day. If you apply modifier 25, you may be able to receive payment on the same day for both the preventative visit and the problem-oriented E/M service or procedural service. Including a modifier 25 regarding the second service reduces the likelihood of incorrect bundling or denial.

See Also: Know your DME HCPCS Codes

The CPT preventive codes 99381–99397 report newborn, child, adolescent, and adult preventative evaluation and management (E/M). These codes are billed alongside the ICD 10 codes. A modifier 25 is often billed with these codes in case additional service is billed. You can increase your likelihood of receiving the correct insurance reimbursements by reviewing the payer’s coding guidelines and reimbursement criteria. Alternatively, you can outsource these complex tasks to professionals like Precision Hub for improved cash flow.

Precision Hub is a leading organization that assists the medical industry with its billing and coding requirements. We assist you with medical billing and coding for your practice. So, schedule your meeting with our expert manager to sort out your medical billing or coding issues.

Know your DME HCPCS Codes

New icd 10 codes for pathology billing – is your practice ready.

My name is Simon and I hold a PhD in Medical Sciences. I bring to Precision Hub my seven years of exposure. As a medical writer, I have contributed to industries as vast as medical devices & med-tech, pharmaceuticals, healthcare agencies, hospitals, health tech firms and healthcare communication agencies.

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  1. 2023 Annual Wellness Visit CPT Codes: G0402, G0438, G0439

    Reimbursement rates are based on a national average and may vary depending on your location. Check the Physician Fee Schedule for the latest information. Learn 2023 CPT billing codes for annual wellness visits (AWVs) and understand requirements to maximize the value of G0402, G0438, G0439, 99497, and G0468.

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    reserved. It is important to note that further CPT Editorial Panel (Panel) or Executive Committee actions may affect CPT codes and/or descriptors. For this reason, code numbers and/or descriptor language in the CPT code set may differ at the time of publication. CPT® Evaluation and Management (E/M) Code and Guideline Changes

  3. Preventive services coding guides

    The AMA offers the following coding guidance to improve the billing process for all. Current Procedural Terminology (CPT) modifier 33 can be used when billing for ACA-designated preventive services with a commercial payer. The addition of modifier 33 communicates to a commercial payer that a given service was provided as an ACA preventive ...

  4. Evaluation and Management (E/M) Code Changes 2023

    The E/M codes for home care services now include any patient residence, including assisted living facilities, which prior to 2023 had a separate code category (99324-99328, 99334-99337). Now all home or residence services are reported using codes 99341-99345 for new patients and 99347-99350 for established patients.

  5. Preventive Medicine Services CPT ® Code range 99381- 99429

    CPT Codes. Evaluation and Management. Preventive Medicine Services. ... October 02, 2023. ... Preventive Visits and ICD 9 Diagnosis Codes. Every preventive visit should be reported with an appropriate ICD-9-CM diagnosis code to reflect the reason for the visit. The most commonly used diagnosis codes associated with preventive services in...

  6. MLN006559

    Reasonable and necessary for prevention or early detection of illness or disability. U.S. Preventive Services Task Force (USPSTF)-recommended with grade A or B. Appropriate for people entitled to Part A benefits or enrolled under Medicare Part B. We may also add preventive services through statutory and regulatory authority.

  7. PDF A 2023 Guide to Preventive and Screening Services Covered by Medicare

    Preventive care can help you stay healthy and find medical problems early. Medicare offers a number of important preventive services — like yearly "Wellness" visits, screenings, and vaccines. Medicare covers two types of preventive visits: 1) "Welcome to Medicare" preventive visit 2) Yearly "Wellness" visit

  8. Preventive Services & Screenings

    The CMS Preventive Services educational tool is available online and provides applicable diagnosis codes for most preventive services and screenings. For further information, please visit the CMS IOM Pub. 100-04, Claims Processing Manual, Chapter 18 and the Preventive Services page on the CMS website.

  9. Preventive Services

    Healthcare Common Procedure Coding System (HCPCS) Outpatient Code Editor (OCE) National Correct Coding Initiative (NCCI) edits ... Annual wellness visits; Initial preventive physical exam; Medicare wellness visits educational tool; Diabetes-related services. ... 12/21/2023 04:36 PM. Help with File Formats and Plug-Ins.

  10. Recommended Ways to Document and Report a Preventive Visit

    CPT® Code: Description: 99381: Initial comprehensive preventive medicine evaluation and management, new patient; 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

  11. PDF ACA Preventive Services Coding Guide

    ACA Preventive Services Coding Guide Revised 5/30/2023 The Patient Protection and Affordable Care Act (PPACA) and the Health Care and Education Reconciliation Act of 2010 (HCERA) has designated the services ... ACA Preventive Services Coding Guide Revised 5/30/2023 Screening for high blood pressure ... For well child visit: Any counseling services

  12. 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.

  13. MLN6775421

    Initial Preventive Physical Exam. The initial preventive physical exam (IPPE), also known as the "Welcome to Medicare" preventive visit, promotes good health through disease prevention and detection. We pay for 1 IPPE per lifetime if it's provided within the first 12 months after the patient's Part B coverage starts. IPPE Components.

  14. PDF 2024 Medicare Advantage preventive screening guidelines

    In 2024, all UnitedHealthcare Medicare Advantage plans have a $0 copayment for in-network diagnostic colonoscopies and therapeutic colonoscopies and sigmoidoscopies. (Exception: Employer group plans may apply outpatient surgery cost-sharing.) 2 Glaucoma screening is $0 for most non-special needs and some employer group plans.

  15. PDF Women's Preventive Services Initiative (WPSI) 2022 Coding Guide

    2022 Coding Guide Well-Woman Preventive Visits* WPSI CODING GUIDE 2022 2 Women's Preventive Services Initiative (WPSI) ... 2023. Services recommended in the previous version will remain available until December 31, 2022. Please see the HRSA Women's Preventive Services Guidelines website for more coverage information.

  16. Documenting and Coding Preventive Visits: A Physician's Perspective

    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 ...

  17. PDF Health Care Reform Preventive Services Coding Guide

    These codes are to be used in the absence of a wellness visit. Aspirin to prevent cardiovascular disease and colorectal cancer in men and women. (Low-dose aspirin use for the primary prevention of cardiovascular disease (CVD) and colorectal cancer (CRC) in adults aged. 50 to 59 years who have a 10% or greater.

  18. Medicare Advantage Preventive Visits

    Initial Preventive Physical Examination (IPPE) w/EG G0402 with G0403, G0404 or G0405 Annual Wellness Visit G0438 (Initial Annual Wellness Visit), G0439 (Subsequent Annual Wellness Visit) Annual Preventive Physical Exam 99381-99387 (New patient) 99391-99397 (Established patient)

  19. Prevention and Screening

    Behavioral counseling for obesity, HCPCS code G0447. Intensive behavioral counseling for cardiovascular disease, HCPCS code G0446. High Intensity Behavioral Counseling to Prevent Sexually Transmitted Illnesses. Screening codes guide: G0442, G0443, G0444, G0446, G0447. Preventive and problem visits. Billing Preventive Medicine Services and ...

  20. Preventive Medicine Services Reporting

    As CPT Assistant (April 2005) notes: 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 ...

  21. PDF CODING FOR Pediatric Preventive Care2022

    to preventive medicine counseling codes (99401-99404) if the patient . is not currently experiencing adverse effects (eg, illness), or include under the problem-related E/M service if patient is present for a sick visit (99202-99215). . Codes . 99406-99409. may be reported in addition to the preventive. medicine service codes. CPT. Codes ...

  22. CPT preventive codes: Coding Guidelines 2022

    CPT preventive codes include 99381-99387 and 99391-99397. 99391-99397: Codes for the preventive exam of an established patient. During a preventive visit, an unexpected item is discovered, an old problem is resolved, and essential E/M, i.e., Evaluation and Management services, are provided.

  23. Understand Preventive/Wellness Visit Coding With These ...

    If the provider does not offer counseling to the patient, you should document 90471-90474 (Immunization administration ...). Age, history, risk factor, and vaccinations set these E/M visits apart. It s safe to say that evaluation and management (E/M) visits make up the largest percentage of the visits to your practice.