CPT code 99395: Preventive outpatient office visit, established patient (18-39 years)

Better understand how to use CPT 99395 and know more about its documentation and billing guidelines.

What is CPT code 99395?

CPT code 99395 is one of the preventive medicine services codes, used when the healthcare provider offers comprehensive preventive medicine services, specifically a preventive medicine visit. It represents a preventive visit wherein an established patient aged 18 to 39 undergoes a preventive medicine encounter and management service.

The routine preventive examination includes the following:

Gathering of an age-appropriate history
Anticipatory guidance
Physical examination and screening tests
Risk factor reduction interventions

The objective of the preventive medicine evaluation is early detection and prevention of disease through health counseling, recommendations of screening services, immunization updates, and lifestyle advice tailored to young adults based on the different factors influencing health status. Conditions commonly discussed include reproductive health, cardiovascular risk assessment, cancer screening, and mental health.

CPT code 99395 documentation requirements

For efficient and accurate preventive medicine coding, healthcare providers must keep note of the following key components that should be present in the patient's documents:

Comprehensive patient history relevant to age-specific preventive care.
Complete physical examination and requests or results of laboratory tests are documented in detail.
Clear documentation of preventive counseling provided, including anticipatory guidance and risk factor discussion.

CPT code 99395 billing guidelines

Ensuring compliance with healthcare regulations means that healthcare providers must be accurate with billing. For a smoother process, they can refer to the following guidelines:

CPT 99395 is billed once annually for established patients aged 18–39.
Although separate billing is permitted for additional problem-oriented E/M services on the same date, it is not necessary. Healthcare providers may instead use a modifier alongside the appropriate office visit code under the same bill.
Verify preventive service coverage and patient eligibility with insurance payers.

Frequently asked questions

The age limit for 99395 is 18 to 39 years old.

The difference is the age limit. While 99395 is for patients aged 18 to 39, 99396 is for patients aged 40-64.

The difference between the two is that 99385 is used for new patients receiving their first comprehensive preventive medicine evaluation, while 99395 is for returning or established patients undergoing re-evaluations.