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Coding for Preventative Counseling

A code can reveal a lot about the care given. Counseling codes can be used alone or in addition to the code for other unrelated medical care.

Physicians, psychologists and others are increasingly using the new CPT[1] (Current Procedural Terminology) codes for preventative counseling[2]. With its origin the Affordable Care Act (ACA)[3], preventative counseling CPT codes allow practitioners to appropriately bill for the work involved with preventative counseling.

Care covered by the preventative counseling CPT codes include: dietary, exercise, injury prevention, HIV and STD prevention, contraception and lifestyle counseling.

Preventative counseling codes are:

  • 99401 (15 minutes)
  • 99402 (30 minutes)
  • 99403 (45 minutes)
  • 99404 (60 minutes)

Also included are tobacco and other substance cessation counseling.

Substance preventative counseling codes are:

  • 99406 (3 – 10 minutes)
  • 99407 (>10 minutes)
  • 99408 (15 – 30 minutes)
  • 99409 (>30 minutes)

If you are reviewing medical bills, you may see these codes for preventative counseling. If there was an office visit for another reason, the practitioner can bill for the E/M visit and for counseling, by adding a -25 modifier to the counseling code.

[1] American Medical Association (AMA): CPT® (Current Procedural Terminology). (2018). Retrieved from https://www.ama-assn.org/practice-management/cpt-current-procedural-terminology

[2] American Academy of Family Physicians, “Documenting and Coding Preventive Visits: A Physician’s Perspective” retrieved from https://www.aafp.org/fpm/2012/0700/p12.html#fpm20120700p12-bt3

[3] Patient Protection and Affordable Care Act, retrieved from https://www.hhs.gov/healthcare/about-the-aca/index.html