Preventive visits are essential for patient wellness, early disease detection, and reducing long-term healthcare costs. Understanding the correct Medicare CPT codes and Commercial Insurance CPT codes ensures accurate medical billing, higher reimbursements, and fewer claim denials.
In this blog, MedAlign Solutions explains the top 15 preventive visit CPT codes, Medicare annual wellness visit guidelines, commercial insurance billing tips, and best practices to maximize revenue cycle management.
1. What Are Preventive Visit CPT Codes in Medical Billing?
Preventive visit CPT codes are used for annual wellness visits, health checkups, and screenings to assess overall health and provide preventive care. These codes are critical for accurate billing, ensuring providers receive timely reimbursement from Medicare and commercial insurance companies.
Using the right CPT code for each patient visit avoids denials and supports efficient medical billing workflows.
2. Medicare Preventive Visit CPT Codes & Billing Guidelines (2025)
Medicare Part B covers preventive visits under specific HCPCS CPT codes. These include the Initial Preventive Physical Exam (IPPE) and the Annual Wellness Visit (AWV).
Medicare Preventive CPT Codes List
| HCPCS Code | Visit Type | Description | Frequency |
|---|---|---|---|
| G0402 | Welcome to Medicare (IPPE) | Complete health risk assessment, screenings & education | Once per lifetime (within first 12 months of enrollment) |
| G0438 | Initial Annual Wellness Visit | First AWV after IPPE, includes prevention plan & risk evaluation | Once per lifetime |
| G0439 | Subsequent Annual Wellness Visit | Follow-up wellness visits updating medical history & care plan | Once every 12 months |
| G0444 | Depression Screening | Screening for depression during AWV | Once per year |
| G0442 | Alcohol Misuse Screening | Counseling for alcohol misuse & risk evaluation | Once per year |
| 99497 | Advance Care Planning | Add-on for end-of-life care discussions during AWV | Billable with G0438/G0439 |
Medicare Preventive Billing Tips:
- Use the correct code sequence → G0402 → G0438 → G0439.
- Bill additional preventive services (e.g., G0444, G0442) when applicable.
- Medicare does not cover routine physicals, only wellness visits.
3. Commercial Insurance Preventive Visit CPT Codes by Age (2025)
Commercial insurance providers like Aetna, Cigna, UnitedHealthcare, and Blue Cross follow CPT guidelines for preventive visits. The codes vary by patient age and new vs. established status.
A. New Patient Preventive Visit CPT Codes (99381 – 99387)
| CPT Code | Age Group | Description |
|---|---|---|
| 99381 | < 1 year | Initial preventive exam for infants |
| 99382 | 1–4 years | Initial preventive exam for toddlers |
| 99383 | 5–11 years | Initial preventive exam for children |
| 99384 | 12–17 years | Initial preventive exam for adolescents |
| 99385 | 18–39 years | Initial preventive exam for young adults |
| 99386 | 40–64 years | Initial preventive exam for adults |
| 99387 | 65+ years | Initial preventive exam for seniors |
B. Established Patient Preventive Visit CPT Codes (99391 – 99397)
| CPT Code | Age Group | Description |
|---|---|---|
| 99391 | < 1 year | Periodic preventive visit for infants |
| 99392 | 1–4 years | Periodic preventive visit for toddlers |
| 99393 | 5–11 years | Periodic preventive visit for children |
| 99394 | 12–17 years | Periodic preventive visit for adolescents |
| 99395 | 18–39 years | Periodic preventive visit for young adults |
| 99396 | 40–64 years | Periodic preventive visit for adults |
| 99397 | 65+ years | Periodic preventive visit for seniors |
4. Key Differences Between Medicare & Commercial Preventive Visit Codes
| Aspect | Medicare (G-Codes) | Commercial Insurance (CPT Codes) |
|---|---|---|
| Code Type | G0402, G0438, G0439 | 99381 – 99397 |
| Eligibility | Patients with Medicare Part B | Privately insured patients |
| Visit Frequency | Initial visit + Annual AWVs | Typically once per year |
| Routine Physicals | Not covered by Medicare | Often covered |
| Screenings | Depression, alcohol, obesity | Varies by plan |
| Documentation | Personalized prevention plan | Complete physical exam |
5. ICD-10 Codes for Preventive Visits
| ICD-10 Code | Description |
|---|---|
| Z00.00 | Adult preventive exam, no abnormal findings |
| Z00.01 | Adult preventive exam, abnormal findings |
| Z00.129 | Child preventive exam, no abnormal findings |
| Z00.121 | Child preventive exam, abnormal findings |
Using ICD-10 Z-codes along with CPT codes ensures accurate reimbursement.
6. Best Practices for Accurate Preventive Visit Billing
- Use correct CPT or HCPCS codes based on patient age & payer type
- Follow Medicare’s G0402 → G0438 → G0439 order
- Check commercial insurance eligibility before billing
- Use modifier 25 for additional E/M services
- Maintain complete documentation to avoid claim rejections
7. Final Thoughts
Accurate preventive visit CPT coding is essential for successful medical billing and revenue cycle optimization. Understanding the difference between Medicare AWV codes and commercial preventive visit CPT codes helps reduce denials and improve reimbursements.
At MedAlign Solutions, we provide medical billing, coding, and RCM services that help healthcare providers maximize collections, reduce claim rejections, and improve compliance.
Let MedAlign Solutions be your trusted partner in billing excellence.
Contact us today for a free consultation and see how we can help you increase revenue, reduce denials, and focus on what matters most, caring for your patients.
Visit us at MedAlign Solutions LLC
Email us: Info@medalignsolutions.com
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