CPT® code 99397 is used to report a comprehensive preventive medicine reevaluation and management (E/M) service for an established patient who is 65 years or older. This service includes an age- and gender-appropriate history, physical examination, and counseling or anticipatory guidance as part of a routine annual wellness or preventive visit.
What is CPT 99397?
This code is designed for asymptomatic patients and is not used to diagnose or treat a specific illness or condition. CPT 99397 covers the full scope of preventive care, including:
- Comprehensive review of medical, family, and social history
- Age-appropriate risk factor screening and health counseling
- Physical examination tailored to preventive care (e.g., vitals, visual acuity, cardiovascular and musculoskeletal checks)
- Guidance on health maintenance, such as diet, exercise, fall prevention, and immunizations
This code reflects the periodic nature of wellness visits and is typically reported once annually, unless payer-specific rules differ.
Note: CPT 99397 is not reported in conjunction with problem-focused E/M codes (e.g., 99214) unless a significant, separately identifiable problem is addressed and documented. In such cases, modifier -25 should be appended to the problem-oriented E/M code.
When to report CPT code 99397
You may report 99397 when:
- The patient is 65 years or older and has been seen by the practice before
- The visit is focused entirely on preventive care, not treatment or evaluation of new/existing conditions
- The encounter includes a comprehensive history, exam, and counseling
- Documentation supports the preventive nature of the service
Additional billing considerations
- Medicare does not cover CPT 99397. Instead, Medicare offers the Annual Wellness Visit (AWV) using HCPCS codes G0438 or G0439. Some Medicare Advantage plans and commercial payers do reimburse 99397, but coverage varies.
- Preventive services may not require cost-sharing, depending on payer policies and the Affordable Care Act.
- Be sure to check payer guidelines for documentation requirements, frequency limits, and bundling rules.
Make Preventive Care Visits Seamless with OptiMantra
OptiMantra empowers providers to deliver and document comprehensive preventive visits like CPT 99397 with ease. Its integrated platform supports:
- Customizable wellness templates based on age, gender, and visit type
- Automated reminders and scheduling tools to encourage annual return visits
- Smart links to evidence-based screenings and health maintenance protocols
- Real-time guidance on payer-specific billing rules and coding requirements
- Patient-friendly portals for pre-visit questionnaires, intake forms, and educational materials
With OptiMantra, practices can streamline their wellness workflows, improve care quality, and maximize reimbursement—all while giving patients a better, more preventive-focused experience.
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