CPT® code 99394 is used to report a periodic comprehensive preventive medicine reevaluation and management (E/M) service for an established patient aged 12 to 17 years. This code represents a routine, age-based wellness visit that includes a complete history, physical examination, and anticipatory guidance or risk-factor counseling.
What is CPT 99394?
CPT 99394 is intended for adolescent patients who have already been seen by the provider or practice, and are returning for a scheduled, preventive check-up. This visit focuses on health maintenance, early detection of risk factors, and support for physical and emotional development during adolescence.
This service typically includes:
- A full review of medical, family, and social history
- An age-appropriate physical exam, including growth, development, and puberty milestones
- Screening for behavioral, emotional, and sexual health risks
- Counseling on lifestyle choices, safety, nutrition, and mental wellness
- Review and update of immunization status and preventive screenings
CPT 99394 is not appropriate for visits that primarily address specific symptoms or illnesses. Those encounters should be coded using problem-oriented E/M codes (e.g., 99213, 99214).
When to report CPT code 99394
You may report 99394 when:
- The patient is between 12 and 17 years old
- The visit is for preventive care, not focused on a new or chronic issue
- The patient is established, meaning they’ve received professional services from the provider or group within the past three years
- The encounter includes a comprehensive history, physical exam, and anticipatory guidance
Billing notes and best practices
- CPT 99394 may be reported annually as part of an adolescent’s preventive care schedule.
- If a separately identifiable problem is addressed during the same visit, report the appropriate E/M code (e.g., 99213) with modifier -25 in addition to 99394.
- Ensure documentation clearly supports the preventive intent of the visit, including any screenings or risk assessments performed.
Coverage of preventive services is typically required under the Affordable Care Act, but check individual payer policies for frequency and documentation guidelines.
Streamline Adolescent Preventive Care with OptiMantra
OptiMantra makes it easy for providers to deliver, document, and bill preventive services like CPT 99394 through its all-in-one EHR and practice management platform. Designed for pediatric, family, and integrative practices, OptiMantra supports:
- Age-specific templates for adolescent wellness visits
- Integrated mental health and risk screening tools (e.g., PHQ-9, CRAFFT)
- Automated tracking of immunizations and preventive health milestones
- Secure patient and parent portals for educational content and communication
- Real-time coding prompts and billing support to ensure accurate reimbursement
With OptiMantra, practices can confidently manage adolescent wellness care—supporting whole-person health while reducing administrative complexity.
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