Summary & Overview
CPT 99389: Comprehensive Preventive Medicine Reevaluation for Seniors
CPT code 99389 represents a periodic comprehensive preventive medicine reevaluation and management service for individuals aged 65 years and older. This code is significant in the national healthcare landscape as it supports preventive care for seniors, a population with increasing healthcare needs. The service is typically delivered in an office setting and is designed to promote wellness, identify risk factors, and facilitate early detection of health issues through regular, thorough assessments.
Blue Cross Blue Shield is a key payer covering this code, reflecting its importance in commercial insurance plans. Readers will gain insights into clinical benchmarks, relevant policy updates, and the broader context of preventive medicine for older adults. The publication also addresses common billing modifiers, associated provider taxonomies, and ICD-10 diagnoses relevant to this service. Additionally, related CPT codes are discussed to provide a comprehensive understanding of preventive and counseling services for seniors. This summary offers a clear overview of the code's clinical purpose, payer coverage, and its role in supporting preventive healthcare nationwide.
CPT Code Overview
CPT code 99389 is used for a periodic comprehensive preventive medicine reevaluation and management of an individual aged 65 years and older. This service is classified as preventive medicine and is typically provided in an office setting (Place of Service 11). The code encompasses a thorough assessment aimed at maintaining health and preventing disease in older adults, including a review of medical history, risk factors, and a physical examination.
Clinical & Coding Specifications
Clinical Context
A typical scenario involves a patient aged 65 years or older presenting to a physician's office for a scheduled periodic preventive medicine reevaluation. The visit is comprehensive, focusing on health maintenance, risk assessment, and screening for common age-related conditions. The physician reviews the patient's medical history, performs a physical examination, updates immunizations, and orders appropriate screening tests such as for diabetes, lipoid disorders, and cardiovascular conditions. The workflow includes documentation of findings, counseling on preventive health measures, and coordination of follow-up care as needed.
Coding Specifications
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Modifiers:
- Modifier
25: Used when a significant, separately identifiable evaluation and management service is performed by the same physician on the same day as another procedure or service. - Modifier
33: Indicates that the service provided is a preventive service.
- Modifier
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Provider Taxonomies:
| Taxonomy Code | Specialty Name |
|---|---|
207Q00000X | Family Medicine Physician |
207R00000X | Internal Medicine Physician |
208D00000X | General Practice Physician |
These taxonomies represent providers who commonly deliver preventive medicine services to older adults.
Related Diagnoses
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Z00.00: Encounter for general adult medical examination without abnormal findings- Used when the preventive visit reveals no abnormal findings.
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Z00.01: Encounter for general adult medical examination with abnormal findings- Used when the preventive visit identifies abnormal findings requiring further evaluation.
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Z13.1: Encounter for screening for diabetes mellitus- Relevant when diabetes screening is performed as part of the preventive visit.
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Z13.220: Encounter for screening for lipoid disorders- Used when screening for lipid disorders is included in the preventive assessment.
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Z13.6: Encounter for screening for cardiovascular disorders- Applied when cardiovascular screening is part of the preventive medicine evaluation.
Each code reflects a specific clinical focus or outcome relevant to the comprehensive preventive medicine service for older adults.
Related CPT Codes
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99397: Periodic comprehensive preventive medicine reevaluation and management, established patient; 65 years and older.- Used for established patients, similar in scope to
99389but for those with an established relationship.
- Used for established patients, similar in scope to
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99401: Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15 minutes.- Often used in conjunction with
99389when additional counseling is provided beyond the standard preventive visit.
- Often used in conjunction with
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99406: Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes.- May be performed during the preventive visit if tobacco use is identified, billed separately if criteria are met.
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99495: Transitional care management services with moderate medical decision complexity.- Used for patients transitioning from inpatient to outpatient care, not typically billed with
99389but relevant in comprehensive care workflows.
- Used for patients transitioning from inpatient to outpatient care, not typically billed with
These codes may be used together or as alternatives depending on the patient's needs and the services provided during the visit.
National Reimbursement Benchmarks
For CPT code 99389, the national mean rate for Blue Cross Blue Shield and BUCA (average commercial) is $80.02. No Medicare benchmark rates are available for this code in the provided data, so a comparison between commercial and Medicare rates cannot be made.
Rate dispersion across both Blue Cross Blue Shield and BUCA is minimal, with the 25th, 50th, and 75th percentiles all at $80.00. This indicates a very tight distribution, with no variation between the lower and upper quartiles for these payers.
The table and chart below present the full breakdown of national mean rates and percentile values for each payer.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.