CPT® code 99404 is used to report a preventive medicine counseling session for an individual patient lasting approximately 45 minutes. This code covers comprehensive counseling aimed at promoting health, preventing disease, and addressing lifestyle factors such as nutrition, exercise, stress management, and risk reduction strategies.
When to Use CPT® Code 99404
- For one-on-one preventive counseling sessions focused on wellness and disease prevention.
- When providing guidance on healthy lifestyle changes, nutrition, physical activity, or behavioral modifications.
- Applicable for both initial wellness visits and follow-up preventive counseling as medically necessary.
- Sessions must involve personalized recommendations and patient education.
Billing Requirements
- Time-based code; typically used for sessions lasting about 45 minutes.
- Documentation should include topics covered, counseling techniques, patient engagement, and goals or action plans.
- May be billed separately from routine preventive visits if additional counseling time is provided.
- Ensure proper ICD-10 codes reflecting preventive care or counseling are included.
Common Clinical Scenarios
- A provider conducts a 45-minute counseling session on weight management, exercise, and nutrition with a patient at risk for metabolic syndrome.
- A wellness clinic provides stress management and lifestyle modification guidance for a patient with high blood pressure.
- A primary care provider addresses preventive care strategies, including smoking cessation, dietary improvements, and activity recommendations.
Streamline Preventive Counseling Documentation with OptiMantra
Accurate documentation and billing for CPT® 99404 ensure compliance and appropriate reimbursement. OptiMantra’s EMR and practice management platform enables providers to track counseling topics, record patient education, and generate clean claims. For primary care, wellness, and integrative clinics, OptiMantra simplifies preventive care workflows, reduces administrative burden, and allows providers to focus on improving patient health outcomes.
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