CPT Code Overview

CPT 99390 is a periodic comprehensive preventive medicine reevaluation and management service for an established patient aged 65 years and older. This code describes a preventive medicine visit focused on age-appropriate screening, counseling, and health maintenance for older adults. The service type is Preventive Medicine and the typical site of service is Office (POS 11).

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Clinical Context

An established patient aged 65 years or older presents to a primary care office (POS 11) for a periodic comprehensive preventive medicine reevaluation and management visit. The visit is scheduled as a preventive medicine encounter focused on health maintenance, age-appropriate screenings, medication review, vaccination status, cognitive and functional assessment, and counseling on lifestyle modifications. The clinical workflow typically includes pre-visit medication reconciliation and vitals, review of prior preventive screening results (e.g., colorectal cancer screening, diabetes risk), point-of-care testing as indicated, comprehensive history and systems review, preventive counseling, and documentation of findings and screening orders. If abnormal findings are identified during the visit, problem-focused work-up or scheduling of follow-up diagnostic testing may be initiated.

Coding Specifications

Modifier 25

• Description: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service.
• When to use: Use when a significant, separately identifiable E/M service is performed on the same day as another procedure or service and must be documented as distinct from the preventive medicine service.

Modifier 33

• Description: Preventive Services.
• When to use: Use to indicate services that are preventive in nature and may be covered without patient cost-sharing under specific payor policies.

Associated provider taxonomies

• Notes: Use the taxonomy that corresponds to the billing provider’s credentialed specialty.

Related Diagnoses

• Z00.00 — Encounter for general adult medical examination without abnormal findings

  • Clinical relevance: Indicates a routine preventive exam with no abnormal findings documented during the comprehensive preventive medicine visit.

• Z00.01 — Encounter for general adult medical examination with abnormal findings

  • Clinical relevance: Captures preventive encounters where new or existing abnormal findings are identified during the evaluation, prompting further assessment or follow-up.

• Z13.1 — Encounter for screening for diabetes mellitus

  • Clinical relevance: Reflects diabetes screening activities (e.g., fasting glucose, HbA1c) conducted as part of the preventive medicine reevaluation.

• Z13.6 — Encounter for screening for cardiovascular disorders

  • Clinical relevance: Represents cardiovascular risk screening (e.g., blood pressure assessment, lipid screening) included in the preventive visit.

• Z12.11 — Encounter for screening for malignant neoplasm of colon

  • Clinical relevance: Denotes colorectal cancer screening activities (e.g., FIT testing, screening orders, referral for colonoscopy) performed or reviewed during the preventive encounter.

Related CPT Codes

• 99397: Similar preventive medicine code for the same age group; listed for direct comparison or coding crosswalks.

• 99213: Represents a problem-focused established patient visit often used when the encounter is primarily for a problem rather than a comprehensive preventive service; may be an alternative if documentation does not meet preventive medicine components.

• 99497: Advance care planning may occur during a comprehensive preventive visit; can be recorded separately when elements of advance care planning are documented per payer rules.

• 99495: Transitional care management occurs after discharge and is a different service line; may be part of continuity planning that follows a preventive visit but is distinct in timing and scope.

Blue Cross Blue Shield and BUCA have identical national mean rates for CPT 99390, both at $80.02, while Medicare is not present in the provided input. The parity between Blue Cross Blue Shield and BUCA represents the reported national average for commercial payers in the data.

Rate dispersion is minimal for the reported payers: both Blue Cross Blue Shield and BUCA show a P25 of $80.00 and a P75 of $80.00, indicating no interquartile spread in the supplied values. Payers without entries in the input are listed as not available. The table and chart below present the full breakdown of the national benchmarks.