CPT Code 99404: Preventive Medicine Counseling, 60 Minutes

Learn more about the documentation requirements and billing guidelines of CPT code 99304 from our guide.

What is the 99404 CPT code?

CPT code 99404 represents "preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual, approximately 60 minutes".

It is used by healthcare professionals or healthcare providers, such as clinical social workers and mental health practitioners, offering preventive medicine services that cover topics regarding diet, physical activity, tobacco cessation, stress management, etc.

Do note that it must only be used when the individual counseling provides to be a separate procedure and isn't bundled with another E/M service or preventive medicine examination.

CPT code 99404 documentation requirements

For accurate documentation of the preventive services provided, the following key elements must be present in the patient's

Date, time, and total time spent (approximately 60 minutes).
Specific topics discussed and counseling approach as well as an initial assessment of the patient's willingness to stop smoking, improve diet, etc.
Clinical notes and patient's progress
Preventive intent and absence of problem management
Resources or referrals given

CPT code 99404 billing guidelines

For a smooth billing process, the guidelines below must be considered:

A separately identifiable evaluation and management service documentation must be provided if billed on the same day as an E/M service.
Medical necessity with a preventive focus must be present in the documentation
Time-based code; ensure the time threshold is clearly met.
Covered variably depending on the payer or insurance company and topic (e.g., tobacco, obesity).