2025 CPT code 99384
(Active) Effective Date: N/A Revision Date: N/A Preventive Medicine - Preventive Medicine Services Evaluation and Management Feed
Initial comprehensive preventive medicine evaluation and management for a new adolescent patient (ages 12-17).
Modifier 25 may be appended if a significant, separately identifiable E/M service is performed on the same day. Modifier 33 (Preventive services) may also apply in some circumstances.
Medical necessity is established by the need for a comprehensive preventive medicine evaluation and management service for a new patient adolescent (12-17 years old) to address age- and gender-appropriate health concerns, provide anticipatory guidance, and promote overall wellness.The service must be medically appropriate for the patient's age and risk factors.
The physician's responsibilities include performing a comprehensive history and physical examination, providing age-appropriate counseling and anticipatory guidance, and ordering necessary diagnostic tests and immunizations.
In simple words: This code covers a doctor's visit for a new patient aged 12-17 for a yearly checkup.The visit includes a complete history, exam, advice on health risks, and ordering of any needed tests.Any vaccines given are billed separately.
This CPT code, 99384, represents an initial, comprehensive preventive medicine evaluation and management service for a new patient aged 12-17 years.The service includes an age- and gender-appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of appropriate laboratory/diagnostic procedures.Immunizations are reported separately.
Example 1: A 15-year-old presents for their first visit to a new pediatrician. The physician performs a complete history, including social and family history, a comprehensive physical exam, discusses adolescent health risks (substance abuse, mental health, sexually transmitted infections), provides anticipatory guidance, and orders a complete blood count and urinalysis., A 12-year-old girl is seen for her first visit with a new gynecologist for a well-woman exam.The visit includes a comprehensive history, pelvic exam, discussion on puberty, menstrual health, and preventive measures (HPV vaccine counseling), and Pap smear., A 17-year-old male athlete is seen for a pre-participation sports physical. The exam includes a thorough musculoskeletal assessment, cardiac evaluation (including auscultation and assessment of murmurs), and discussion on sports-related injuries and preventative measures. A urinalysis and EKG are also ordered.
Detailed documentation should include the comprehensive history (including social and family history, relevant medical history), physical examination findings, counseling provided (including specific risk factor reduction interventions and anticipatory guidance), results of any ordered tests and/or procedures, and immunizations administered (separately reported).
** This code should only be used for new patients.Established patient preventive medicine visits are coded differently.Always refer to the most current CPT codebook and payer guidelines for the most up-to-date information.
- Revenue Code: M1A (Office Visits - New)
- Payment Status: Active
- Specialties:Pediatrics, Adolescent Medicine, Family Medicine
- Place of Service:Office