PREVENTIVE MEDICINE SERVICES, NEW PATIENT
Initial preventive medicine services are typically well-patient examinations for new patients with code selection dependent upon the patient’s age. These services include applicable patient history and examination, guidance/recommendation regarding personal risk factors, and any laboratory and/or diagnostic procedures ordered. Clinicians are not required to report minor or self-limiting problems or complaints noted during the course of the preventive examination when those problems do not require any additional work or necessitate performing the key components of a problem oriented E/M service. CPT code 99381 is reported for infants younger than 1 year of age; CPT code 99382 for children 1 to 4 years of age; CPT code 99383 for children 5 to 11 years of age; CPT code 99384 for adolescents12 to 17 years of age; CPT code 99385 for adult patients 18 to 39 years of age; CPT code 99386 for patients 40 to 64 years of age; and CPT code 99387 for patients 65 years of age and older.
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 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
Related ICD-10 codes
Z00.110 Health supervision for newborn under 8 days old
Z00.111 Health supervision for newborn 8 to 28 days old
Z00.121 Routine child health exam with abnormal findings
Z00.129 Routine child health exam without abnormal findings
Z00.00 General adult medical exam without abnormal findings
Z00.01 General adult medical exam with abnormal findings
Preventive services (99381-99387, 99391-99397) are not time-based services, and they are not affected by the E/M 2021 changes. Code selection for preventive service evaluations should be reported as they have always been. However, if time is used for selection of a level of office/outpatient E/M code, the time spent on the preventive service cannot be counted toward the time for 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. Modifier 25 will still need to be appended to the problem assessment of the E/M visit, as appropriate, when providing dual E/M services, as was previously required prior to the 2021 E/M changes.
Modifier 33, Preventive Services, was created to identify services as preventive and allow payer processing systems to waive the deductible associated with the co-payment and co-insurance cost and has been in effect since January 1, 2011. An example of when modifier 33 is helpful is when it is appended to the code for a diagnostic or surgical procedure performed for preventive purposes. When a test becomes a diagnostic or surgical service on the date of a screening service, modifier 33 may be used to indicate that the patient encounter was initiated as a preventive service, but it was converted to a therapeutic service that is not considered to be a covered preventive service. The most common example of this is screening colonoscopy (code 45378), which was initiated as a preventive service, but resulted in a polypectomy (code 45383) instead.
PREVENTIVE MEDICINE SERVICES, ESTABLISHED PATIENT
Periodic comprehensive preventive medicine services are typically well-patient examinations for established patients presenting for reevaluations and/or management of overall health condition with code selection dependent upon the patient’s age. These services include applicable patient history and examination, guidance/recommendation regarding personal risk factors, and any laboratory and/or diagnostic procedures ordered. Clinicians are not required to report minor or self-limiting problems or complaints noted during the course of the preventive examination when those problems do not require any additional work or necessitate performing the key components of a problem oriented E/M service. CPT code 99391 is reported for infants younger than 1 year of age; CPT code 99392 for children 1 to 4 years of age; CPT code 99393 for children 5 to 11 years of age; CPT code 99394 for adolescents12 to 17 years of age; CPT code 99395 for adult patients 18 to 39 years of age; CPT code 99396 for patients 40 to 64 years of age; and CPT code 99397 for patients 65 years of age and older.
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)
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
Related ICD-10 codes
Z00.110 Health supervision for newborn under 8 days old
Z00.111 Health supervision for newborn 8 to 28 days old
Z00.121 Routine child health exam with abnormal findings
Z00.129 Routine child health exam without abnormal findings
Z00.00 General adult medical exam without abnormal findings
Z00.01 General adult medical exam with abnormal findings