What is an unlisted preventive medicine service?
CPT code 99429 as maintained by American Medical Association is used to report unlisted preventive medicine services when no specific CPT code exists for the service rendered. It applies to customized screenings, professionals who would perform a wellness exam or related assessments, or interventions that are not otherwise defined in CPT or other preventive medicine services.
This medical procedural code includes services like executive physicals, wellness screenings not covered under annual exams, or preventive services provided in occupational health contexts.
99429 CPT Code documentation requirements
Providers must include:
- Detailed description of the preventive service performed
- Rationale for the service (e.g., employer-mandated physical, yearly wellness exam)
- Time spent and elements covered (e.g., counseling, assessments, perform medication management sessions)
- Comparison to any similar CPT-coded service (for pricing reference)
- Signed attestation by the provider
Include any patient education or referrals arising from the service, especially if tied to the US Preventive Services Task Force or other preventive services task force findings.
99429 CPT code billing guidelines
Here are some reminders when you are billing for this procedure:
- Requires manual pricing and is subject to payer review.
- Must include a letter of explanation when submitting to insurance.
- Not billable with standard preventive service codes (e.g., 99381–99397) or overlapping services listed under the range other preventive medicine CPT codes.
- Does not guarantee reimbursement—check payer policy, especially if a Correct Coding Initiative (CCI) edit applies.
Ensure proper use to avoid redundancy with existing well-defined CPT services or incorrect bundling per the Correct Coding Initiative CCI.
Other relevant CPT codes
- 99381–99387 – Preventive exams, new patient
- 99391–99397 – Preventive exams, established patient
- 99401–99404 – Preventive counseling
Frequently asked questions
Insurer coverage for CPT code 99429 varies, so it’s important to check individual payer policies for reimbursement eligibility.
CPT code 99499 is used for reporting an unlisted evaluation and management service when no specific CPT code exists for the service provided. It is a catch-all code that requires detailed documentation to justify the nature and complexity of the service for proper billing and reimbursement.
It is recommended, especially if pricing justification is needed or when using an online subscription system to manage appointments and care sessions.
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