Code Preventive And Non Face Services - Certified Professional Coder CPC

1. Which modifier is appended to the problem-focused E/M code to allow it to be reported separately on the same date as the preventive medicine service?
   Answer: 25 Modifier 25 is appended to a significant, separately identifiable evaluation and management service when it is performed on the same day as a preventive medicine service or a minor procedure. When a physician performs a complete preventive medicine evaluation and also separately evaluates and manages a new or exacerbated condition (new-onset hypertension) during the same encounter, both services are separately reportable: the preventive code (e.g., 99396) plus the problem-focused E/M code with modifier 25 (e.g., 99213-25), as long as each is fully documented. Modifier 57 applies when an E/M results in the decision to perform a major surgical procedure (90-day global); hypertension management is not a surgical decision. Modifier 24 applies to unrelated E/M services during an active postoperative global period. Modifier 51 applies to multiple surgical procedures, not E/M services. The preventive-plus-problem-focused-visit scenario is the classic application of modifier 25 outside of a procedural context.
2. A physician conducts a 15-minute synchronous audio-only (telephone) E/M service with an established patient. No video connection is available. Which CPT® code is reported?
   Answer: 98012 CPT® 98012 describes a synchronous audio-only evaluation and management visit with an established patient with straightforward medical decision making; when coding by total time, 10 or more minutes must be met or exceeded. A 15-minute audio-only encounter with an established patient meets the ≥10-minute threshold for 98012. Code 98013 describes an audio-only established-patient visit with low medical decision making; when coding by time, 20 or more minutes must be met or exceeded — 15 minutes does not reach this threshold. Codes 99441 and 99442 were the prior telephone E/M codes (5-10 min and 11-20 min respectively), both deleted effective January 1, 2025, and replaced by the 98008-98015 synchronous audio-only E/M series. The 2025 codes (98008-98015) are selected based on new-vs.-established patient status and either medical decision-making complexity or total time; all require more than 10 minutes of medical discussion.
3. Which CPT® code is reported for this periodic preventive medicine visit for an established patient, age 50?
   Answer: 99396 CPT® 99396 describes periodic comprehensive preventive medicine evaluation for an established patient aged 40 to 64 years — the correct code for an annual preventive visit when the patient has an existing relationship with the physician and falls within the 40-to-64 age range. Code 99385 describes an initial preventive visit for a new patient aged 18 to 39; this is an established patient aged 50, requiring a periodic code in the 40-64 range. Code 99387 describes an initial preventive visit for a new patient aged 65 or older; this is both a periodic (not initial) visit and the patient is 50, not 65. Code 99395 describes a periodic preventive visit for an established patient aged 18 to 39; the patient is 50, placing her in the 40-64 age range. Established vs. new patient status and age bracket are the two axes for all preventive medicine codes.
4. Which CPT® code is reported for the first 30 minutes of advance care planning?
   Answer: 99497 CPT® 99497 describes advance care planning including the explanation and discussion of advance directives, first 30 minutes face-to-face with the patient and/or surrogate — the correct code for a standalone 30-minute ACP conversation. Code 99498 is the add-on for each additional 30 minutes beyond the first; since only 30 minutes of ACP is performed here, only 99497 is reported and 99498 is not needed. Code 99402 describes preventive medicine counseling (not advance care planning) for approximately 30 minutes; while both involve a face-to-face discussion, 99497 specifically captures advance directive/goals-of-care conversations. Code 99404 describes preventive medicine counseling for approximately 60 minutes. Advance care planning codes (99497/99498) are specifically designed for goals-of-care conversations and advance directive completion, distinguishing them from general preventive counseling codes.
5. A physician conducts a 20-minute synchronous audio-only (telephone) E/M service with an established patient. No video connection is available. Which CPT® code is reported?
   Answer: 98013 CPT® 98013 describes a synchronous audio-only evaluation and management visit with an established patient with low medical decision making; when coding by total time, 20 or more minutes must be met or exceeded. A 20-minute audio-only encounter with an established patient exactly meets the ≥20-minute threshold, making 98013 the correct code. Code 98012 describes an audio-only established-patient visit with straightforward MDM; when coding by time, ≥10 minutes must be met — 20 minutes meets 98012 but also meets the higher-level 98013 threshold, so 98013 is selected per the rule of using the highest code whose threshold is met. Code 99441 was the prior telephone E/M code for 5 to 10 minutes of medical discussion, deleted effective January 1, 2025, and replaced by the 98008-98015 synchronous audio-only E/M series. Code 98014 describes an audio-only established-patient visit with moderate MDM; when coding by time, ≥30 minutes must be met — 20 minutes does not reach this threshold. The 2025 audio-only codes (98008-98015) require more than 10 minutes of medical discussion and are selected by MDM complexity or total time, whichever is higher.
6. Which CPT® code is reported for the remote physiologic monitoring device supply with daily recordings and transmission, per 30-day period?
   Answer: 99454 CPT® 99454 describes remote physiologic monitoring device supply with daily recordings or programmed alert transmissions for each 30-day period — the correct code for the ongoing supply and transmission service (the hardware and data-collection component of remote monitoring). Code 99453 describes the initial setup and patient education for remote physiologic monitoring — a one-time code reported at the beginning of monitoring when the device is first provided and the patient is trained; it is not the ongoing per-30-day supply code. Code 99457 describes remote physiologic monitoring treatment management services (the clinical staff's review and response to the data), first 20 minutes per calendar month; this is the clinical management code, not the device/supply code. Code 99091 describes collection and interpretation of physiologic data transmitted by the patient/caregiver — an older code used when data are batch-reviewed, now often replaced by the RPM series. Remote monitoring billing involves separate codes for setup (99453), device supply (99454), and clinical management time (99457).
7. Which CPT® code is reported for the first 20 minutes of remote physiologic monitoring treatment management per calendar month?
   Answer: 99457 CPT® 99457 describes remote physiologic monitoring treatment management services — time spent by clinical staff and/or the physician reviewing transmitted data, communicating with the patient, and adjusting the treatment plan — first 20 minutes per calendar month. This is the clinical management component of remote monitoring, distinct from the device/supply code. Code 99454 describes the remote monitoring device supply with daily data transmission for each 30-day period — the hardware and data-collection component, not the clinical management time. Code 99453 describes initial RPM setup and patient education — reported once at enrollment, not for ongoing monthly management. Code 99458 is the add-on for each additional 20 minutes of RPM treatment management beyond the first (used with 99457); it cannot be reported as a standalone primary code. The RPM billing sequence is: 99453 once at setup, then 99454 each 30 days for data collection, and 99457/99458 each month for clinical management.
8. Which CPT® code is reported for home health care plan oversight services of 30 or more minutes per calendar month?
   Answer: 99378 CPT® 99378 describes physician supervision of a patient under care of a home health agency (requiring complex and multidisciplinary care modalities), 30 minutes or more per calendar month — the correct code for home health care plan oversight when the physician's monthly oversight time meets or exceeds 30 minutes. Code 99377 describes home health care plan oversight for 15 to 29 minutes per calendar month; the physician's time (35 minutes) exceeds this threshold, requiring 99378. Code 99374 describes care plan oversight for a patient in a domiciliary or rest home under hospice care, 15-29 minutes; this patient is under home health (not hospice), and the time exceeds 29 minutes. Code 99375 describes hospice care plan oversight, 30 or more minutes per month — also for hospice, not home health. Home health oversight codes (99377/99378) differ from hospice oversight codes (99374/99375) by setting.
9. Which CPT® code is reported for this periodic preventive medicine visit for an established patient, age 14?
   Answer: 99394 CPT® 99394 describes periodic comprehensive preventive medicine evaluation for an established patient aged 12 to 17 years — the correct code for an annual well-adolescent visit in an established patient who is 14 years old. Code 99384 describes an initial preventive visit for a new patient aged 12 to 17; this is an established patient, requiring the periodic (not initial) code. Code 99385 describes an initial preventive visit for a new patient aged 18 to 39; the patient is 14 (adolescent age group) and is an established patient. Code 99393 describes periodic preventive medicine for an established patient aged 5 to 11 (late childhood); the patient is 14, in the adolescent range. Established patient status and age 12-17 together identify 99394.
10. Which CPT® code is reported for the first 20 minutes of chronic care management services in a calendar month?
    Answer: 99490 CPT® 99490 describes chronic care management services, clinical staff time, first 20 minutes per calendar month — the correct code for initiating CCM billing when at least 20 minutes of qualifying clinical staff time (directed by a physician or qualified health professional) is spent on care management activities for a patient with two or more chronic conditions. Code 99487 describes complex chronic care management requiring 60 or more minutes per calendar month with moderate-to-high-complexity decision making; the time documented (22 minutes) does not reach the 60-minute threshold for complex CCM. Code 99439 is an add-on for each additional 20 minutes of chronic care management services beyond the first 20 minutes (used with 99490); it cannot be reported as a standalone primary code. Code 99491 describes physician-directed chronic care management services (each additional 20 minutes add-on). The 22 minutes documented includes the first 20 reportable under 99490; additional time beyond 20 minutes would support adding 99439.
11. Which CPT® code is reported for the administration of a single intranasal vaccine?
    Answer: 90473 CPT® 90473 describes immunization administration by intranasal or oral route, first administration — the correct code for the first vaccine administered by a non-injection route (intranasal spray or oral) in a single encounter. Intranasal influenza vaccines such as FluMist require 90473 for the first administration rather than the injection-route code 90471. Code 90471 describes immunization administration by the injection route (percutaneous, intradermal, subcutaneous, or intramuscular); the intranasal route is not an injection. Code 90472 is the add-on for each additional injection beyond the first; it applies to the injection route only. Code 90474 is the add-on for each additional intranasal or oral vaccine beyond the first; since only one intranasal vaccine is administered here, 90474 is not needed. Administration route — injection (90471/90472) versus intranasal/oral (90473/90474) — determines the correct immunization administration code.
12. Which CPT® code is reported for this periodic preventive medicine visit for an established patient, age 62?
    Answer: 99396 CPT® 99396 describes periodic comprehensive preventive medicine evaluation for an established patient aged 40 to 64 years — the correct code for an annual well visit in an established patient who is 62 years old. Code 99387 describes an initial preventive visit for a new patient aged 65 or older — this patient is both established (not new) and 62 (not 65+). Code 99386 describes an initial preventive visit for a new patient aged 40 to 64; this is an established patient of 3 years, requiring a periodic code. Code 99395 describes periodic preventive medicine for an established patient aged 18 to 39; the patient is 62, outside this age range. Established patient status and age 40-64 together identify the periodic code 99396.
13. Which CPT® code is reported for this periodic preventive medicine visit for an established patient, age 72?
    Answer: 99397 CPT® 99397 describes periodic comprehensive preventive medicine evaluation for an established patient aged 65 years or older — the correct code for an annual preventive visit in an established patient who is 72 years old. Code 99387 describes an initial preventive visit for a new patient aged 65 or older; this is an established patient of 12 years, requiring the periodic (not initial) code. Code 99396 describes periodic preventive medicine for an established patient aged 40 to 64; the patient is 72, above the 40-64 age range. Code 99395 describes periodic preventive medicine for an established patient aged 18 to 39. Age 72 with established status identifies 99397 (periodic, 65+); age 72 as a new patient would instead require 99387 (initial, 65+).
14. Which CPT® code is reported for this initial preventive medicine visit for a new patient, age 15?
    Answer: 99384 CPT® 99384 describes initial comprehensive preventive medicine evaluation for a new patient aged 12 to 17 years — the correct code for a first-time adolescent well visit at a new practice. Code 99394 describes a periodic (established patient) preventive visit for the 12-17 age group; this is a new patient, requiring the initial code. Code 99385 describes an initial preventive visit for a new patient aged 18 to 39; the patient is 15, placing him in the adolescent category (12-17). Code 99383 describes an initial preventive visit for a new patient aged 5 to 11 (late childhood); the patient is 15, beyond this age range. For initial preventive medicine visits, the correct age categories are: infant (<1 year) 99381, early childhood (1-4) 99382, late childhood (5-11) 99383, adolescent (12-17) 99384, young adult (18-39) 99385, adult (40-64) 99386, and senior (65+) 99387.
15. Which CPT® code is reported for this initial preventive medicine visit for a new patient, age 35?
    Answer: 99385 CPT® 99385 describes initial comprehensive preventive medicine evaluation and management for a new patient aged 18 to 39 years — the correct code for a first-time preventive visit with this physician for a patient in that age bracket. Initial preventive codes (99381-99387) apply when the patient is new to the practice; periodic codes (99391-99397) apply for established patients. Code 99395 describes a periodic (established patient) preventive visit for a patient aged 18-39; this is a new patient, requiring an initial code. Code 99386 describes an initial preventive visit for a patient aged 40 to 64; the patient is 35, placing him in the 18-39 age range. Code 99384 describes an initial preventive visit for an adolescent patient aged 12 to 17; the patient is 35. Patient age and new-vs.-established status are the two determinants for all preventive medicine E/M codes.
16. Which CPT® code combination is reported for the administration of two injectable immunizations?
    Answer: 90471 and 90472 CPT® 90471 describes immunization administration including percutaneous, intradermal, subcutaneous, or intramuscular injections, first injection — the primary code reported once for the first vaccine administered by injection. CPT® 90472 is the add-on code for each additional injection administered at the same encounter. For two injections, the correct reporting is 90471 (first injection) + 90472 (second injection). Reporting 90471 twice would duplicate the primary code, which is not permitted; the add-on code 90472 captures all injections after the first. Reporting 90472 twice is incorrect because 90472 is an add-on code that requires a primary code (90471) and cannot be reported as a standalone primary service. Modifier 51 is used for multiple surgical procedures, not immunization administration services. The primary-plus-add-on structure (90471 for the first, 90472 for each additional) applies regardless of the number of injections given.
17. Which CPT® code is reported for complex chronic care management services requiring 60 or more minutes per calendar month?
    Answer: 99487 CPT® 99487 describes complex chronic care management services, clinical staff time per calendar month, requiring at least 60 minutes of care management activity and moderate-to-high-complexity medical decision making — the correct code when the duration (65 minutes) and MDM complexity of the CCM services meet the complex threshold. Code 99490 describes standard (non-complex) chronic care management, first 20 minutes per calendar month, with lower MDM requirements; the complexity and duration here exceed 99490. Code 99491 describes physician-directed chronic care management services (each additional 20 minutes add-on). Code 99439 is the add-on for each additional 20 minutes of standard CCM beyond the first 20 minutes (add-on to 99490); it is not the correct primary code for complex CCM. Complex CCM (99487) requires both the 60-minute time threshold and moderate-to-high MDM complexity, distinguishing it from standard CCM (99490).
18. Which CPT® code does the treating physician report for this interprofessional telephone consultation preparation?
    Answer: 99452 CPT® 99452 describes interprofessional telephone/internet/EHR consultation — treating/requesting physician or other qualified health care professional service; preparation of information and communication with the consultant, 16 to 30 minutes per reporting period — the correct code for the treating physician's time (20 minutes) spent preparing and communicating about the patient with the consultant. Code 99446 describes a brief interprofessional consultation (5-10 minutes) from the consultant's perspective — this code is reported by the consulting specialist, not the requesting physician. Code 99451 describes the consultant's service (patient record review and verbal/written report back to the treating physician), 5 minutes or more — the code used by the endocrinologist/consultant, not the treating primary care physician. Code 99449 describes an interprofessional consultation lasting 31 or more minutes — the consultation here is 20 minutes. The treating physician's preparation code (99452) is distinguished from the consultant's response codes (99446-99449/99451).
19. Which CPT® code is reported for this initial preventive medicine visit for a new patient younger than 1 year?
    Answer: 99381 CPT® 99381 describes initial comprehensive preventive medicine evaluation for a new patient who is younger than 1 year of age (infant) — the correct code for a first-time well-baby visit in the infant age group at a new practice. Code 99391 describes a periodic (established patient) preventive visit for an infant younger than 1 year; this is a new patient, requiring the initial code. Code 99382 describes an initial preventive visit for a new patient aged 1 to 4 years (early childhood); the patient is 9 months, still in the infant category (under 1 year). Code 99392 describes a periodic visit for an established patient aged 1 to 4 years. The infant age category (younger than 1 year) for initial preventive visits is 99381; the same age group for established patients uses 99391.
20. Which CPT® code is reported for transitional care management with moderate-complexity medical decision making?
    Answer: 99495 CPT® 99495 describes transitional care management services with moderate-complexity medical decision making, with first contact (interactive communication) made within 2 business days of discharge — the correct code when the postdischarge contact is made within 2 business days AND the face-to-face visit involves moderate-complexity MDM. Code 99496 describes transitional care management with high-complexity MDM; the physician's decision making is moderate, not high complexity. Code 99490 describes chronic care management (first 20 minutes per calendar month) — an ongoing care management service for patients with chronic conditions, not a postdischarge transitional care service. Code 99497 describes advance care planning — unrelated to transitional care management. The MDM complexity level (moderate for 99495 vs. high for 99496) is the sole differentiator between the two TCM codes when both require first contact within 2 business days.

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