Modifier 25 can be used with procedure 99396, which is a preventive medicine evaluation and management service. This modifier indicates that a significant, separately identifiable E/M service was performed on the same day as another procedure. If a patient receives a preventive visit along with a separate, medically necessary service during the same encounter, modifier 25 would be appropriate to indicate the additional service. However, proper documentation must support the necessity of the additional E/M service.
Yes.
preventative medicine, age 40-64
Modifier 59 is used to represent a different session or patient encounter, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same physician. You would not use modifier 59 on an E&M service such as 99396.
what.
Yes, a modifier 25 should be used when billing both 99214 (an office visit) and 99396 (a preventive medicine service) on the same day. Modifier 25 indicates that a significant, separately identifiable evaluation and management service was performed on the same day as a preventive service. This helps to clarify to payers that the office visit was necessary beyond the routine preventive care provided. Always ensure that documentation supports the use of this modifier.
99396
preventative medicine, age 40-64
Periodic comprehensive preventive medicine
99396 is a CPT code, not an ICD9 code. The ICD9 code you use will depend on the condition or reason for the visit.
Ambetter typically covers preventive services, including certain evaluations and screenings, which may encompass medical code 99396 (a periodic comprehensive preventive medicine evaluation and management service for established patients). However, coverage can vary by plan and state, so it's essential to verify specific benefits with Ambetter directly or consult your healthcare provider for confirmation. Always check for any required prior authorizations or criteria that need to be met for coverage.
99396