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Shade Posted Thu 11th of December, 2014 13:13:58 PM

As per my several questions on biometrics, some insurance asked us to use wellness code ranging 99381 to 99397 for biometric screening. i believe that is more for annual physical which is pay for by insurance annually.however as per the cpt guide lines, 99401 to 99402, will be more appropriate. please help and explain in detail the right and appropriate code to use. thank you. i will appreciate a quick answer.

SuperCoder Answered Thu 11th of December, 2014 16:03:46 PM

Thank you.

We did receive your initial question regarding this and currently working on it. We will have a response shortly.

SuperCoder Answered Thu 11th of December, 2014 16:56:09 PM

When billing/coding for Biometric Screening, 99429 should be used. Biometric Screening alone does not support the Preventive Medicine Codes 99381-99387. These codes require much more intensive documentation and are typically only paid once per calendar/benefit year for subscribers.

99499-Unlisted preventive medicine service -The provider performs a preventive medicine service that is not represented by any of the standard and active CPT® codes available.

When reporting a procedure with an unlisted code, submit a cover letter to the insurance explaining the reason for choosing the unlisted code instead of a defined, active code. Include one or more similar codes, and compare your service to those codes to justify the claim amount you are billing. Also include the operative notes or other relevant documentation to strengthen the claim and to avoid a possible denial. Your payers will consider claims with unlisted procedure codes on a case by case basis, and they will determine payment based on the documentation you provide.

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