Go Back   AAPC Forum > Medical Coding > E/M
Forum Rules FAQ Members List Calendar Search Today's Posts Mark Forums Read

Thread Tools
Old 11-20-2008, 03:06 PM
MICHB010375 MICHB010375 is offline
Join Date: Apr 2007
Posts: 7
MICHB010375 is on a distinguished road
Default Preventative Counseling 99401

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!
Reply With Quote
Old 11-21-2008, 10:18 AM
clm6 clm6 is offline
Join Date: Apr 2007
Posts: 1
clm6 is on a distinguished road
Default 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.

Last edited by clm6; 11-21-2008 at 10:19 AM. Reason: add name
Reply With Quote
Old 03-17-2009, 10:19 AM
ewilson ewilson is offline
Join Date: Apr 2007
Posts: 1
ewilson is on a distinguished road

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.
Reply With Quote

Thread Tools

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off

Disclaimer: Although AAPC staff members will monitor these forums periodically, we cannot be responsible for the information posted herein, nor guarantee its accuracy. Our members may discuss various subjects related to medical coding, but none of the information should replace the independent judgment of a physician for any given health issue. Please note that the opinions expressed here do not necessarily reflect those of AAPC.

All times are GMT -6. The time now is 06:11 PM.

Powered by vBulletin® Version 3.8.1
Copyright ©2000 - 2015, Jelsoft Enterprises Ltd.
Copyright ?2015, AAPC