2025 CPT code 99397
(Active) Effective Date: N/A Revision Date: N/A Evaluation and Management - Preventive Medicine Services Feed
Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 65 years and older.
Modifier 25 may be applicable if a separately identifiable E/M service is performed on the same day. Modifier 33 should be used when reporting preventive services for patients with Medicare or other payers who require it.
Medical necessity for this code is based on the patient's age (65 years or older) and the need for a periodic comprehensive preventive evaluation to maintain and improve health and prevent future illness. Payers may have specific guidelines regarding the frequency of these visits.
The physician or other qualified healthcare professional is responsible for performing an age and gender appropriate history and examination, providing counseling/anticipatory guidance on risk factor reduction, and ordering appropriate laboratory/diagnostic procedures based on the patient's individual needs.
In simple words: This is an annual wellness visit for established patients 65 and older. It includes a comprehensive checkup based on the patient's age and gender, counseling about health risks and ways to prevent them, and ordering any necessary lab tests.Immunizations and additional services for specific health problems are billed separately.
This code represents a comprehensive preventive medicine re-evaluation and management service for an established patient aged 65 years or older.It includes an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of appropriate laboratory/diagnostic procedures.
Example 1: A 70-year-old established female patient presents for her annual wellness visit. The physician performs a comprehensive history and physical exam, reviews her medications, discusses fall prevention and healthy lifestyle choices, and orders routine lab work., A 65-year-old established male patient with a history of hypertension presents for an annual wellness visit.The physician performs a physical exam, reviews his current medications, orders labs to monitor his hypertension, and counsels him on diet and exercise., An 80-year-old established male patient presents for an annual wellness visit. The physician performs a physical exam, noting decreased mobility.He orders lab tests and refers the patient to physical therapy to improve his mobility.
Documentation should include a comprehensive history and physical exam relevant to the patient's age and gender, details of counseling/anticipatory guidance provided (including risk factor reduction interventions), and documentation of the medical necessity for any ordered laboratory/diagnostic procedures. Documentation of any chronic conditions managed during the visit should also be included.
** If an abnormality is encountered during the preventive visit that requires additional workup beyond the scope of a preventive service, a separate E/M service (e.g., 99212-99215) may be billed with modifier 25.
- Revenue Code: M1B (OFFICE VISITS - ESTABLISHED)
- Global Days: This is a preventive service, not a procedure, and therefore doesn't have global days.
- Payment Status: Active
- Modifier TC rule: Not Applicable
- Specialties:Internal Medicine, Family Medicine, Geriatrics, General Practice
- Place of Service:Office, Home, Skilled Nursing Facility, Nursing Facility, Assisted Living Facility