When you provide individual preventive counseling to a patient regarding risk factor reduction (e.g., diet, exercise, substance abuse), it is billed using CPT 99401 through 99404.
Time-Based Increments
These are time-based codes requiring face-to-face counseling:
- 99401: ~15 minutes
- 99402: ~30 minutes
- 99403: ~45 minutes
- 99404: ~60 minutes
Crucial Rule: No Existing Illness
These codes are strictly for preventive medicine counseling. If the patient already has an illness (e.g., diabetes) and you are counseling them on diet to manage that illness, you must use standard E/M codes based on time or MDM, NOT 99401.
NCCI Edits
These codes are highly prone to bundling. They generally cannot be billed on the same day as a comprehensive preventive medicine E/M visit (99381-99397) because counseling is considered part of the preventive exam.