2025 CPT code 99429
(Active) Effective Date: N/A Revision Date: N/A Preventive Medicine Services - Other Preventive Medicine Services Evaluation and Management Feed
Unlisted preventive medicine service; used when no other CPT code adequately describes the service provided.
Modifier 25 may be appended to another E/M code if significant and separately identifiable E/M services were provided on the same day. Other modifiers may be applicable depending on the specific circumstances.
Medical necessity for code 99429 must be clearly demonstrated in the documentation.The documentation should convincingly justify why a standard preventive medicine code is insufficient and why the additional time and services are medically necessary for the patient's condition.
The physician or qualified healthcare professional is responsible for performing a comprehensive preventive medicine service that cannot be adequately described by any other existing CPT code. This requires thorough documentation to support medical necessity and justify the billing.
- Evaluation and Management
- Evaluation and Management > Preventive Medicine Services > Other Preventive Medicine Services
In simple words: This code is used when a doctor performs a preventive health service that doesn't have a specific code.The doctor must explain why this code was used and give details about the service performed.
CPT code 99429 is reported for an unlisted preventive medicine service.This code is used only when no other CPT code accurately reflects the preventive medicine service performed.Detailed documentation, including a comparison to similar existing codes and justification for the unlisted code's use, must accompany the claim submission.
Example 1: A patient presents for a comprehensive wellness visit, and during the exam, the physician discovers an unusual skin lesion requiring further investigation beyond the scope of a standard preventive medicine visit. Code 99429 might be used to bill for the additional time spent evaluating the lesion, along with the appropriate preventive medicine code., A patient requires extensive genetic counseling related to a family history of a specific disease. The discussion and assessment exceed the typical time allotted for a standard preventive medicine visit.99429 could be appended to the appropriate preventive medicine code to reflect the extra time spent., A patient presents for a routine wellness check, but during the visit, extensive time is spent counseling the patient on complex medication management for multiple chronic conditions beyond the typical scope of a standard preventive visit. 99429 can be used to represent the additional counseling and coordination.
Comprehensive documentation is essential for billing 99429. This should include a detailed description of the preventive medicine service performed,the reason why no other CPT code accurately reflects the service, a time log specifying the duration of the service (in 15-minute increments), and a comparison to similar CPT codes with justification for using the unlisted code.Supporting medical records and notes should be included.
** Consider using Category III codes if a similar, temporary code exists.Always include a detailed explanation of the service, time involved, and justification for using an unlisted code.Failure to provide comprehensive documentation will likely result in claim denial.
- RVU: The relative value units (RVUs) for this code will vary depending on the payer and the specific services rendered.It's crucial to refer to the payer's specific fee schedule for reimbursement information.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Fee Schedule: Historical fee schedule data is not readily available for unlisted codes.Reimbursement rates are determined by the payer based on the submitted documentation.
- Specialties:All specialties providing preventive medicine services.
- Place of Service:Office, Outpatient