2025 CPT code 99401
(Active) Effective Date: N/A Evaluation and Management - Preventive Medicine Services Feed
Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15 minutes.
Modifier 25 can be appended to an E/M service code if a separately identifiable E/M service is performed on the same day. Modifier U5 is used if counseling is provided for less than 15 minutes but more than 8 minutes.
Medical necessity for this code is established when the counseling is provided to promote health and prevent future illness or injury based on the patient's individual risk factors, age, and health status.
The physician or other qualified healthcare professional is responsible for providing face-to-face counseling to the individual patient.This includes discussing and educating the patient on risk factors, healthy lifestyle choices, and preventive measures related to age, family history, and individual concerns.
In simple words: This code covers a roughly 15-minute discussion with your doctor or other healthcare provider about how to stay healthy and prevent future health problems. It's separate from your regular check-up and might involve talking about things like diet, exercise, or other healthy habits.
This code represents a face-to-face encounter with a physician or other qualified healthcare professional for preventive medicine counseling and/or risk factor reduction interventions provided to an individual.The encounter is separate from a preventive medicine exam and focuses on promoting health and preventing illness or injury.Counseling typically addresses issues like family problems, diet and exercise, substance use, sexual practices, injury prevention, dental health, and review of diagnostic and laboratory test results.The service is time-based, lasting approximately 15 minutes.
Example 1: A 45-year-old patient with a family history of heart disease receives counseling on diet, exercise, and cholesterol management., A teenager receives counseling on safe sex practices and substance abuse prevention., A patient reviews recent lab results with their physician and discusses lifestyle changes to address borderline high cholesterol.
Documentation should include the total time spent on counseling, the specific topics discussed, any educational materials provided, and the patient's response to the counseling.