Wiki Preventative Counseling 99401

[MICHB010375]

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!

 

[clm6]

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.
Cheryl

 

[ewilson]

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.