CPT Codes & Their Age Limits For Periodic Preventive Medicine Services

Periodic preventive medicine services play a crucial role in maintaining overall health and well-being. Understanding the importance of these services and the corresponding CPT codes is essential for both healthcare providers and patients. In this guide, we will delve into the significance of periodic preventive medicine services, explore the corresponding CPT codes, and provide age limits for each code.

CPT Codes & Their Age Limits For Periodic Preventive Medicine Services

Periodic Preventive Medicine Services

Periodic preventive medicine services encompass a range of screenings, assessments, and interventions aimed at detecting and preventing health problems before they escalate. These services not only promote early detection of diseases but also emphasize health promotion and disease prevention strategies.

Understanding CPT Codes & Their Age Limits For Periodic Preventive Medicine Services

As we know CPT codes are standardized codes used to document medical procedures and services for billing and reimbursement purposes. Below mentioned are the common CPT codes associated with periodic preventive medicine services:

CPT CodeAge CategoryPatients Age
99391InfantYounger than 1 year
99392Early Childhood1 through 4 years old
99393Late Childhood5 through 11 years old
99394Adolescent12 through 17 years old
99395Adult18 through 39 years old
99396Adult40 through 64 years old
99397Adult65 years and older
Age Limits For Periodic Preventive Medicine Services

1. Description & Age Limit of CPT Code 99391

Periodic comprehensive preventive medicine evaluation and management of an individual, including an age and gender-appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of appropriate immunization(s), laboratory/diagnostic procedures, and medications, with the aim of preventing illness or detecting it at an early stage.

CPT Code 99391 Age Limit

The CPT Code 99391 typically covers Infant under the age of 1 year.

2. Description & Age Limit of CPT Code 99392

Periodic comprehensive preventive medicine evaluation and management of an individual, including an age and gender-appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of appropriate immunization(s), laboratory/diagnostic procedures, and medications, with the aim of preventing illness or detecting it at an early stage.

Age Limit For CPT Code 99392

The CPT Code 99392 usually applies to early childhood patients between the ages of 1 and 4 years.

Read More: CPT Code For Echocardiography

3. Description & Age Limit of CPT Code 99393

Periodic comprehensive preventive medicine evaluation and management of an individual, including an age and gender-appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of appropriate immunization(s), laboratory/diagnostic procedures, and medications, with the aim of preventing illness or detecting it at an early stage.

Age Limit for CPT Code 99393

This CPT code typically covers children’s who are in their late childhood. They are generally, between the ages of 5 to11 years.

4. Description & Age Limit of CPT Code 99394

Periodic comprehensive preventive medicine evaluation and management of an individual, including an age and gender-appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of appropriate immunization(s), laboratory/diagnostic procedures, and medications, with the aim of preventing illness or detecting it at an early stage.

Age Limit for CPT Code 99394

This CPT code generally, applies to patients between the ages of 12 to17 years.

5. Description & Age Limit of CPT Code 99395

Periodic comprehensive preventive medicine evaluation and management of an individual, including an age and gender-appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of appropriate immunization(s), laboratory/diagnostic procedures, and medications, with the aim of preventing illness or detecting it at an early stage.

Age Limit For CPT Code 99395

Typically covers patients between the ages of 18 to 39 years.

6. Description & Age Limit of CPT Code 99396

Periodic comprehensive preventive medicine evaluation and management of an individual, including an age and gender-appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of appropriate immunization(s), laboratory/diagnostic procedures, and medications, with the aim of preventing illness or detecting it at an early stage.

Age Limit For CPT Code 99396

Usually applies to patients between the ages of 40 to 64 years.

7. Description & Age Limit of CPT Code 99397

Periodic comprehensive preventive medicine evaluation and management of an individual, including an age and gender-appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of appropriate immunization(s), laboratory/diagnostic procedures, and medications, with the aim of preventing illness or detecting it at an early stage.

Age Limit For CPT Code 99397

Generally covers patients aged 65 years and older.

Diagnoses Must Support Preventive Nature of the Visit CPT code 99391, 99392, 99393, 99394, 899395, 99396 & 99397

For the Periodic comprehensive preventive medicine services every billed service must be supported by latest ICD-10 codes that describe the reason for that billable service. However, In the case of a well visit as there is no patient complaint so we should turn to “Z codes” (Factors influencing health status and contact with health services). For example:

DX CodeDescription
Z00.110Health examination for newborn under 8 days old
Z00.111Health examination for newborn 8 to 28 days old
Z00.121Encounter for routine child health examination with abnormal findings
Z00.129Encounter for routine child health examination without abnormal findings
Z00.00Encounter for general adult medical examination without abnormal findings
Z00.01Encounter for general adult medical examination with abnormal findings
Z01.411Encounter for gynecological examination (general) (routine) with abnormal findings
Z01.419Encounter for gynecological examination (general) (routine) without abnormal findings

Conclusion:

Periodic preventive medicine services are integral to maintaining optimal health and well-being across all stages of life. By familiarizing yourself with the corresponding CPT codes and age limits, you can ensure that individuals receive timely and appropriate preventive care. Prioritizing preventive medicine services not only improves individual health outcomes but also contributes to the overall well-being of communities.

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