Healthcare Insights
Top 10 preventive medicine CPT codes
Preventive medicine is a type of medicine that protects patients and communities from avoidable disability, illness, and death. Healthcare providers offer testing, counseling, and immunizations to prevent illness and identify potential health concerns as they emerge.
Preventive medicine is a vital component of healthcare because it promotes overall wellness, reduces the occurrence of illness, and saves resources.
Using data from the Atlas All-Payor Claims Database, we compiled a list of the top 10 preventive medicine CPT codes below.
| Rank | HCPCS/CPT code | Description | % total procedures | Explore dataset |
|---|---|---|---|---|
| 1 | 99397 | Preventive evaluation/management visit for established patient, age 65+ | 36.20% | Explore |
| 2 | 99396 | Preventive evaluation/management visit for established patient, age 40-64 | 17.00% | Explore |
| 3 | 99406 | Intermediate smoking and tobacco use cessation counseling visit, 3-10 min. | 13.90% | Explore |
| 4 | 99401 | Preventive counseling on patient's age, family history, and areas of concern, 15 min. | 8.10% | Explore |
| 5 | 99395 | Preventive evaluation/management visit for established patient, age 18-39 | 7.40% | Explore |
| 6 | 99402 | Preventive counseling on patient's age, family history, and areas of concern, 30 min. | 5.50% | Explore |
| 7 | 99387 | Comprehensive preventive medicine evaluation/management visit for new patient, age 65+ | 2.90% | Explore |
| 8 | 99407 | Intensive smoking and tobacco use cessation counseling visit, 10+ min. | 2.60% | Explore |
| 9 | 99386 | Preventive evaluation/management visit for new patient, age 40-64 | 1.60% | Explore |
| 10 | 99411 | Preventive counseling and risk factor reduction for group | 1.20% | Explore |
Fig. 1 Analysis of data from the Definitive Healthcare Atlas All-Payor Claims Database representing procedure claims for January – December 2023. Data accessed September 2024
What was the top preventive medicine CPT code?
The top preventive medicine CPT code was 99397, a preventive visit for an established patient between aged 65 or older, representing over 36% of all preventive medicine claims in 2023, the most recent full year of data available.
The 65+ age group is particularly susceptible to conditions like Alzheimer’s disease, diabetes, colon cancer, and osteoporosis. Preventive services are especially valuable to patients who face greater risk of illness and injury, whether due to age, comorbidities, lifestyle, or other factors.
The second most commonly used CPT code was 99396, a preventative visit for an established patient between 40 and 60 years of age. The third most common preventive medicine CPT code was 99409, a 3- to 10-minute intermediate counseling session on smoking and tobacco use cessation.
When analyzing all preventive medicine CPT codes for 2023, nearly 95% of preventive medicine claims were for established patients rather than new patients. This suggests that most preventive medicine services are for patients who have already received care from the provider.
Why do many people forgo preventive care?
Without health insurance, medical care can be costly and difficult to navigate. For this reason, individuals who do not have health insurance often forgo preventive care. A Bankrate survey found that in 2020, 32% of families in the U.S. did not seek medical care in the past 12 months due to cost.
A study from the Centers for Disease Control and Prevention found four influencers of preventive care. First, and most prominently, was finances, followed by the use of metrics driving change in the healthcare system, and the role of healthcare payors. The final influencing factor was changes in healthcare reimbursement models.
Individuals who do not receive preventive care are at increased risk for disabilities, diseases, and death.
What preventive care is not covered by Medicare?
Medicare Part B covers a wide variety of preventive and screening services for common chronic conditions as well as rare diseases, infections, and behavioral concerns. These include screenings for cancer, diabetes, glaucoma, cardiovascular disease, depression, sexually transmitted infections, and many other biomarkers and measurements.
Medicare does not cover preventive services related to most dental care, cosmetic dermatological conditions, and eye exams for the purpose of fitting glasses.
What is a CPT code?
The Current Procedural Terminology (CPT) is a system of codes used for reporting healthcare services and medical procedures. CPT codes increase the efficiency and accuracy of healthcare reporting and billing.
Definitive Healthcare tracks many CPT codes across diagnostic, medical, and surgical areas. This information can give you insight into diagnosis, procedure, and prescribing activity and transform your sales and marketing strategies.
Learn more
To hear more about the long-term implications of pandemic-related delays in care, including preventive care, listen to our podcast with Dr. Mark Pimentel.
Healthcare Insights are developed with healthcare commercial intelligence from the Definitive Healthcare platform. Want even more insights? Start a free trial now and get access to the latest healthcare commercial intelligence on hospitals, physicians, and other healthcare providers.
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