2025 CPT code 99402
(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 an individual (separate procedure); approximately 30 minutes.
Modifier 25 is appropriate if this code is billed on the same day as another E/M service for a significant, separately identifiable service.Modifier 33 (Preventive Services) may also be used, depending on payer requirements.
Medical necessity is established when the counseling addresses specific risk factors identified in the patient's history or through recent testing. This may include family history of disease, lifestyle choices (diet, exercise, substance use), or results from screening tests. The counseling should be focused on preventing disease and promoting health.
The physician or other qualified healthcare professional provides face-to-face counseling to the patient. The counseling covers topics relevant to the patient's age, family history, and identified risk factors. This includes discussing ways to reduce risk and improve overall health, such as diet, exercise, and preventive screenings.
- Evaluation and Management > Preventive Medicine Services
- Evaluation and Management > Preventive Medicine Services > Counseling Risk Factor Reduction and Behavior Change Intervention
In simple words: This code is for a roughly 30-minute meeting with a doctor to talk about preventing health problems. The doctor will discuss things based on your age, family history, and concerns, helping you make healthier choices and avoid risky behaviors.
This CPT code, 99402, represents preventive medicine counseling and risk factor reduction interventions provided to an individual patient in a face-to-face encounter separate from a comprehensive preventive medicine examination.The session lasts approximately 30 minutes and focuses on age-appropriate topics, family history, and areas of concern to prevent future health problems and reduce risky behaviors.This service is distinct from other E/M services and should be reported separately using modifier 25 if performed on the same day as other E/M services.The time spent on this counseling should not be included in determining the level of E/M service provided.
Example 1: A 25-year-old female patient presents for a separate counseling session to discuss family history of heart disease and ways to mitigate her risk. The session includes discussion of diet, exercise, and stress management, lasting approximately 30 minutes., A 60-year-old male patient who recently received abnormal cholesterol results during a preventive visit needs additional counseling on dietary changes and exercise strategies to reduce his cardiovascular risk factors.The session lasts 30 minutes., A 16-year-old adolescent receives counseling on reproductive health, sexually transmitted infections, and safe sex practices during a 30-minute session, separate from their annual wellness exam.
Detailed documentation should include the date of service, the patient's age and gender, the specific topics discussed, the time spent counseling, any patient education materials provided, and a summary of the patient's understanding and plan of action.The documentation should clearly differentiate this service from any other E/M services performed on the same day.
** This code is intended for counseling services provided separately from a preventive medicine visit.It is crucial to maintain clear and detailed documentation to support the medical necessity and distinctiveness of this service from other E/M services, especially when billed on the same day. Payer policies may vary; always check for specific coverage rules and requirements.
- Revenue Code: M1B (Office Visits - Established)
- RVU: The relative value units (RVUs) for this code will vary based on geographic location, payer, and other factors.Consult the appropriate fee schedule for the specific RVU values.
- Global Days: Not applicable. This is not a surgical procedure.
- Payment Status: Active
- Modifier TC rule: Not applicable. This is not a procedure with technical and professional components.
- Fee Schedule: Historical fee schedules are not readily available and vary by payer and geographic location. Please consult your local fee schedule for historical data.
- Specialties:Family Medicine, Internal Medicine, Pediatrics, Geriatrics
- Place of Service:Office, Outpatient, Telehealth Provided in Patient’s Home, Telehealth Provided Other than in Patient’s Home