2025 CPT code 99411
(Active) Effective Date: N/A Revision Date: N/A Preventive Medicine - Counseling Risk Factor Reduction and Behavior Change Intervention Evaluation and Management > Preventive Medicine Services Feed
Preventive medicine counseling and/or risk factor reduction intervention(s) provided to individuals in a group setting; approximately 30 minutes.
Modifier 25 may be added if a significant, separately identifiable evaluation and management service was also provided on the same day.Modifier 33 (Preventive Services) may also apply depending on payer guidelines.
Medical necessity for this code is established when patients have identifiable risk factors requiring preventative counseling or intervention to minimize or avoid future complications or disease.
The physician or qualified healthcare professional leads a group counseling session focused on preventive medicine and risk factor reduction.They provide guidance, address patient concerns, and offer strategies for maintaining health and well-being.
- Evaluation and Management > Preventive Medicine Services
- Evaluation and Management > Preventive Medicine Services > Counseling Risk Factor Reduction and Behavior Change Intervention
In simple words: The doctor or other healthcare professional spends about 30 minutes with a group of patients giving advice on how to stay healthy and reduce health risks. This could cover topics like diet, exercise, or avoiding risky behaviors.
This CPT code reports preventive medicine counseling and/or risk factor reduction interventions provided to a group of individuals.The service encompasses approximately 30 minutes of face-to-face time with a physician or other qualified healthcare professional.Counseling may address various topics relevant to the age and circumstances of the patients, such as family issues, diet and exercise, substance use, sexual practices, injury prevention, dental health, and the interpretation of diagnostic and laboratory test results.
Example 1: A group of patients with newly diagnosed type 2 diabetes meet for a 30-minute session to discuss lifestyle modifications, including diet and exercise, to manage their condition and prevent complications., A group of adolescent girls attends a 30-minute session focusing on reproductive health, including safe sex practices and preventative measures against sexually transmitted infections., A group of elderly patients with hypertension participates in a 30-minute session reviewing medication adherence, lifestyle adjustments, and managing stress to control blood pressure and reduce cardiovascular risks.
Detailed notes should document the date, time, and location of the group session.The number of patients present, specific topics discussed, and individual patient participation should be recorded.Any relevant materials or handouts distributed should be documented.The provider's assessment of patient understanding and engagement should also be included.
** The documentation must clearly indicate that the 30-minute time requirement was met.The code should not be reported if the counseling is part of another service, such as a comprehensive preventive medicine examination.Pay close attention to payer-specific guidelines regarding the use of modifiers.
- Revenue Code: M1B (OFFICE VISITS - ESTABLISHED)
- Payment Status: Active
- Specialties:Family Medicine, Internal Medicine, Pediatrics, Geriatrics
- Place of Service:Office, Outpatient Hospital, Community Health Center