Summary & Overview
CPT 99402: Preventive Counseling, 30-Minute Session
CPT code 99402 represents a discrete, approximately 30-minute counseling encounter focused on prevention and risk-factor reduction delivered separate from a preventive medicine visit. Nationally, this code matters as a mechanism to capture structured, age- and family-history–appropriate counseling that addresses lifestyle, behavioral risks, and preventive topics — services that can reduce long-term morbidity if delivered effectively. Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will learn what CPT code 99402 covers clinically, where the service is typically delivered, and which payers commonly reimburse for this counseling-focused service. The publication summarizes standard service characteristics, common modifiers used with counseling codes (listed separately), and practical billing considerations such as session duration and separation from preventive medicine visits. It also outlines benchmarking and policy updates where available, and provides clinical context to help coding, billing, and compliance teams understand when CPT code 99402 is appropriate to report. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 99402 describes a standalone counseling visit focused on prevention and risk-factor reduction. The service is provided at an encounter separate from a preventive medicine visit and is tailored to the patient’s age, family history, and areas of concern. Use of this code corresponds to a counseling session lasting approximately 30 minutes.
Service Type
- Preventive counseling / Behavioral counseling
Typical Site of Service
- Outpatient clinic
- Physician office
- Other ambulatory care settings
Clinical & Coding Specifications
Clinical Context
A 32-year-old patient presents to a primary care clinic specifically for a dedicated preventive counseling visit separate from an annual physical. The patient requests focused counseling on lifestyle modification after reporting a family history of premature coronary artery disease and recent elevated blood pressure readings at home. The clinical workflow includes scheduling a standalone 30-minute counseling appointment; review of medical and family history; focused risk assessment (blood pressure, BMI, smoking status, diet, activity); tailored counseling on diet, exercise, tobacco cessation, and cardiovascular risk reduction; documentation of time spent and topics covered; and provision of written materials and follow-up plan. This visit is billed as a separate counseling service distinct from an established preventive medicine visit and is appropriate when the counseling requires approximately 30 minutes of face-to-face time.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service | Use when a distinct evaluation is performed on the same day as another service in addition to the counseling visit, documented separately. |
59 |