Wiki Preventative Counseling 99401

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Preventative Counseling 99401

The Patient Protection and Affordable Care Act of 2010 specifies that a health risk assessment (HRA) must be included as part of the preventive medicine counseling visit. This assessment includes all activities known only to an individual patient, such as smoking, physical activity, and nutritional habits. The purpose of this assessment is to allow the provider to provide feedback tailored to the information collected (prior to or during the visit) to promote health, and to reduce illness and injury (see
Health risk assessment (HRA) CPT® codes include:
• 99401 Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15 minutes
• 99402 …approximately 30 minutes
• 99403 …approximately 45 minutes
• 99404 …approximately 60 minutes
Per CPT Assistant (March 2016):
Codes 99401-99412 are used to report services provided face-to-face by a physician or other qualified health care professional for the purpose of promoting health and preventing illness or injury. These codes may be used to report the following counseling and/or behavior change intervention circumstances for:
• Persons whose behavior has not yet resulted in illness, or
• Persons whose behavior may exacerbate a condition and/or is considered an illness (eg, tobacco use/addiction, substance abuse/misuse, or obesity).
Preventive medicine counseling and risk factor reduction interventions will vary with age and should address such issues as family problems, diet and exercise, substance use, sexual practices, injury prevention, dental health, and diagnostic and laboratory test results available at the time of the encounter. For example:
A patient and his family arrive at their family practice office to see the physician for counseling and instructions regarding the patient’s desire to start a healthy eating plan. The physician meets with the patient and his family to discuss the benefits of a healthy diet, and to discuss some of the physical changes that will accompany such a diet, such as weight loss, increased energy, improved mood, and so on. The physician then recommends that the family meet with a registered dietician to outline line a meal plan, and discusses how to incorporate this lifestyle into their day-to-day life. Start time: 9:30am. Stop time: 10:00am.
Correct CPT® code assignment is 99402. These services are distinct from E/M services, and may be reported separately when performed by a qualified health care professional as a separate encounter.
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Is anyone billing Medicare procedure 99401 with a 25 modifier? If so how are you getting reimbursed. I could not find a Medicare allowable or a LCD on the procedure. Thanks!


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Preventive Counseling

Medicare won't cover 99401-99404. These are considered routine and - obviously - preventive.

The wording in CPT changed in this section of codes for 2008.

2007's notes said this:
"These codes are not to be used to report counseling and risk factor reduction interventions provided to patients with symptoms or established illness. For counseling individual patients with symptoms or established illness, use the appropriate office, hospital or consultation or other E/M codes."

In 2008, we see this:
"These codes are used to report services provided face-to-face by a physician or other qualified health care professional for the purpose of promoting health and preventing illness or injury. They are distinct from evaluation and management (E/M) services that may be reported separately when performed.

SO, it used to be that you could not use these codes in addition to an E/M, but now it looks like you can. However, the 25 modifier would go on the office visit, NOT on 99401.

You CANNOT code preventive counseling on the same day as a comprehensive preventive medicine service (Routine Physical 99381-99397)). It's already included.
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I work in a psychiartist office and they want to use this code 99401 for counseling of lifestyle in order to prevent obesity etc... and so they will not end up having to take more medication that they already do. Can I bill for this will a 90862-25. Will any insurance pay for this. I do not even know what the allowable charge is. Medicare has no listing of this code. I need some help.