Summary & Overview
CPT 99397: Periodic Preventive Medicine Reevaluation for Established Adults
Headline: CPT 99397 Targets Comprehensive Preventive Care for Established Adults
Lead: CPT 99397 denotes a comprehensive periodic preventive medicine reevaluation and management visit for established adult patients focused on history-taking, physical examination, counseling, risk-reduction, and ordering necessary tests. This code supports preventive care delivery and coding consistency across outpatient primary care settings.
What the code represents and why it matters: CPT 99397 specifies an annual-type preventive encounter for adults that bundles age- and gender-appropriate assessment, counseling, and preventive screening orders. Nationally, the code is central to primary care practices' delivery of preventive services, quality measurement, and alignment with preventive care guidelines.
Key payers covered: Analysis includes coverage and coding context for major national payers: Aetna; Blue Cross Blue Shield; Cigna Health; and UnitedHealthcare.
Overview of what readers will learn: The publication outlines clinical scope and billing context for CPT 99397, compares it to adjacent preventive codes for established patients, summarizes common coverage considerations and modifier usage, and highlights typical office-based implementation. It provides benchmarks for utilization patterns, common clinical scenarios that fit the code, and policy considerations relevant to preventive care coding.
Data notes: Data not available in the input for any payer-specific rates or state-limited policies.
CPT Code Overview
CPT 99397 is a periodic comprehensive preventive medicine reevaluation and management visit for an established adult patient. The service includes an age- and gender-appropriate history, comprehensive examination, counseling/anticipatory guidance, risk factor reduction interventions, and ordering of laboratory or diagnostic procedures as indicated.
Service Type: Preventive Medicine Evaluation and Management
Typical Site of Service: Office (POS 11)
Clinical & Coding Specifications
Clinical Context
A 68-year-old established patient presents to a primary care office for an annual periodic preventive medicine evaluation. The visit is scheduled in the office (POS 11) with a family medicine or internal medicine clinician. The clinician completes an age- and gender-appropriate history, a focused physical examination, counseling and anticipatory guidance (including fall risk, immunizations, and lifestyle counseling), and orders age-appropriate screening tests such as colon cancer screening and cardiovascular risk screening. The encounter is documented as a preventive medicine visit and coded as 99397. If abnormal findings are identified during the examination or screening review, the clinician documents the findings and any follow-up plans within the same visit.
Coding Specifications
-
Modifiers:
-
25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service — Use when a separate E/M service distinct from a procedure or other service is provided on the same calendar day and is documented as a distinct, significant evaluation and management encounter in addition to the preventive service. -
33: Preventive Services — Use to indicate the service is a preventive service when required or accepted by the payer; identifies the visit as preventive in nature.
-
-
Associated provider taxonomies:
-
2084P0800X— Family Medicine (represents Family Medicine practitioners)
-