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Do people still bill for Individual Risk Counseling?

obinna Posted Tue 25th of November, 2014 14:43:50 PM

I know the CPT code used to be 99401 but what about now, can I still bill cpt code 99401 for Individual Risk Counseling? Do they still reimburse for Individual Risk Counseling?

SuperCoder Answered Wed 26th of November, 2014 07:22:59 AM

Not all payers cover preventive counseling codes (99401 – 99404). Medicare does not cover this service. Please check with your payer.

Thanks !!

obinna Posted Thu 11th of December, 2014 13:14:53 PM

What if preventive counseling (99401) was billed together with a preventive visit (99393) and an office visit (99212). How would it be billed like?

I know the office visit (99212) will definitely have modifier 25 appended to it but what about the preventive counseling (99401), is a modifier supposed to be appended to 99401 as well?

SuperCoder Answered Thu 11th of December, 2014 14:00:12 PM

Thanks for your question. You should not bill a preventative visit (99393), established office visit (99212), and a preventative counseling visit (99401) together. When billing 99401; Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15 minutes; it is only billed when the encounter is separate from a preventative medicine visit. You may bill an established office visit with a preventative visit when a problem arises during the encounter. A modifier 25 may be appended to the office visit if it is a separate service. See attached links for further information. Hope this helps.

https://www.supercoder.com/coding-newsletters/my-pediatric-coding-alert/use-modifier-25-to-properly-code-for-visits-requiring-multiple-services-article

https://www.supercoder.com/coding-newsletters/my-family-practice-coding-alert/patients-health-is-key-factor-in-coding-for-counseling-article

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