2025 CPT code 99403
(Active) Effective Date: N/A Revision Date: N/A Deletion 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 45 minutes.
Modifier 25 may be appended if a significant, separately identifiable E/M service was performed on the same day.
Medical necessity is established when the patient presents without a specific illness, and counseling is required to address preventive measures or modify risk factors.The documentation should clearly demonstrate the need for the extended counseling session.
The provider conducts a face-to-face counseling session with the patient lasting approximately 45 minutes to discuss preventative measures, risk factors, and behavior modification strategies based on the patient's age, history, and any relevant test results.
- 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 covers a meeting with a doctor to talk about ways to stay healthy and avoid getting sick.The meeting lasts about 45 minutes and focuses on things like healthy eating, exercise, avoiding risky behaviors, and managing family issues. It's separate from a regular doctor visit and usually happens after any tests have been done.
This CPT code reports preventive medicine counseling and/or risk factor reduction interventions provided to an individual during a separate encounter from a preventive medicine visit.The session lasts approximately 45 minutes and addresses age-appropriate issues such as family problems, diet and exercise, substance use, sexual practices, injury prevention, dental health, and review of available diagnostic and laboratory test results.This code is used for individuals without a specific illness for which the counseling might otherwise be used as part of treatment.The counseling should focus on preventing problems from developing and reducing risky choices and behaviors.This service is distinct from evaluation and management (E/M) services and should be reported separately. If E/M services are performed on the same day, modifier 25 should be used.
Example 1: A 35-year-old female patient presents for counseling regarding family planning options after reviewing her recent pap smear results., A 16-year-old male patient receives counseling on substance abuse prevention and healthy relationship building., A 60-year-old male patient is counseled on risk factors for cardiovascular disease and provided guidance on diet and exercise modifications.
Detailed documentation should include the date of service, the time spent in counseling, the topics discussed (with specific examples), any patient education materials provided, and a summary of the patient's understanding and plan for implementation of recommendations.Note that the service is separate from a preventive medicine visit. Any related lab results or other findings should be referenced.
** This code should only be used for preventive counseling sessions lasting approximately 45 minutes that are separate from other E/M services.If the session is shorter or longer, a different code may be required (99401, 99402, 99404). The counseling must focus on risk factor reduction and prevention of future illness.
- Revenue Code: M1B (Office Visits - Established)
- RVU: This information is not available in the provided text.RVUs vary by payer and location and are subject to change.
- Global Days: Not applicable. This code represents a separate encounter for counseling and is not associated with a global surgical period.
- Payment Status: Active
- Modifier TC rule: Not applicable. This is not a procedure with a technical component.
- Fee Schedule: This information is not available in the provided text and will vary by payer and geographic location.Historical fee data is subject to change.
- Specialties:Family Medicine, Internal Medicine, Pediatrics
- Place of Service:Office