2025 CPT code 99404
(Active) Effective Date: N/A Revision Date: N/A Preventive Medicine - Preventive Medicine Counseling Evaluation and Management > Preventive Medicine Services Feed
Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 60 minutes.
Modifier 25 may be appended if a significant, separately identifiable E/M service is performed on the same day.
Medical necessity is established when the patient presents without an established diagnosis and the counseling is focused on preventing future illness and promoting overall wellness. Documentation must clearly demonstrate the rationale for the preventive counseling session.
The provider conducts a 60-minute counseling session focused on preventive medicine and risk factor reduction, tailored to the patient's age, health status, and family history.This may include discussing lab results, promoting healthy habits, and addressing potential health risks.
- Evaluation and Management > Preventive Medicine Services
- Evaluation and Management > Preventive Medicine Services
In simple words: This code covers a roughly 60-minute counseling session with a doctor focusing on preventing health problems and making healthy choices.The doctor will discuss things like diet, exercise, and avoiding risky behaviors, tailored to your age and health history. This is separate from a regular checkup.
This CPT code reports preventive medicine counseling and/or risk factor reduction interventions provided to an individual during a separate encounter, lasting approximately 60 minutes.The counseling 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 service is distinct fromevaluation and management (E/M) services and should be reported separately.If significant problems are addressed requiring additional work beyond the preventive medicine service, the appropriate E/M code should be reported with modifier 25.
Example 1: A 45-year-old woman with a family history of heart disease receives counseling on diet, exercise, and stress management to reduce her cardiovascular risk. , A 16-year-old adolescent receives counseling on safe sex practices, sexually transmitted infections (STIs), and healthy relationships., A 60-year-old man with elevated cholesterol and blood pressure receives counseling on lifestyle modifications, medication adherence, and monitoring his health parameters.
Detailed documentation should include the date of service, patient's age and relevant medical history, specific topics addressed during the counseling session (e.g., nutrition, exercise, substance abuse, sexual health), duration of the session (approximately 60 minutes), and any patient education materials provided.Note any significant problems addressed and whether they required additional work (modifier 25).
** The time spent should be documented accurately as the code's appropriateness relies on a roughly 60-minute session.The service must be provided face-to-face by a qualified healthcare professional.This code is for preventive counseling separate from preventive medicine examinations (99381-99397).
- Revenue Code: M1B (Office Visits - Established)
- RVU: This information is not available in the provided text.Consult the current year's CPT codebook or your payer's fee schedule for RVU values.
- Global Days: Not applicable; this is a counseling service, not a procedure with a global surgical period.
- Payment Status: Active
- Modifier TC rule: Not applicable; this is a counseling service, not a procedure with technical components.
- Fee Schedule: This information is not available in the provided text and varies by payer. Consult the relevant fee schedule.
- Specialties:Family Medicine, Internal Medicine, Pediatrics, Adolescent Medicine
- Place of Service:Office