Initial preventive medicine, age 18-39 years, established patient
Audit Defense & Denial Intelligence
Research-based denial patterns from OrbDoc Bill Analyzer
1. Age doesn't match code range - early childhood 1-4 years
Very Common99382 is for new patient preventive visits, early childhood (ages 1-4 years). Denied when patient is under 1 year (use 99381) or 5+ years (use 99383 for 5-11, 99384 for 12-17). Age boundaries strictly enforced. Particular attention to children at age boundaries (just turned 1, just turned 5).
Common Causes
- • Child under 1 year - should be 99381
- • Child 5 years or older - should be 99383 or 99384
- • Age miscalculation at scheduling vs. visit date
Resolution Strategy
Verify age at visit date. Correct to appropriate age-specific code and resubmit. These denials easily resolved with proper age documentation and code correction.
Relative Value Units (RVUs)
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Clinical Information
When to Use
Comprehensive preventive medicine evaluation for established patients age 18-39
Common Scenarios
Documentation Requirements
- Comprehensive age and gender-appropriate history
- Complete physical examination
- Anticipatory guidance and risk factor counseling
- Appropriate preventive screening orders
- Review of immunization status
Coding Guidelines
Common Modifiers
Bundling Rules
- Cannot be billed with new patient preventive codes (99382-99387)
- Can be billed with problem-based E/M using modifier 25 if significant problem addressed
- Includes counseling and anticipatory guidance
Exclusions
- 99201-99215 (problem-based office visits without modifier 25)
- 99392-99397 (new patient preventive codes)
- G0438-G0439 (Medicare Annual Wellness Visit for Medicare patients)
Coding Notes
Clinical scenarios
- Comprehensive age and gender-appropriate history
- Complete physical examination
- Anticipatory guidance and risk factor counseling
- Comprehensive age and gender-appropriate history
- Complete physical examination
- Anticipatory guidance and risk factor counseling
- Comprehensive age and gender-appropriate history
- Complete physical examination
- Anticipatory guidance and risk factor counseling
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Frequently Asked Questions
CPT 99382 is the billing code for "Initial preventive medicine, age 18-39 years, established patient". Comprehensive preventive medicine evaluation for established patients age 18-39
Medicare pays approximately $111.27 for CPT 99382 (national average). Actual payment varies by geographic location due to GPCI adjustments. Hospital and commercial insurance rates are typically 2-4x higher than Medicare rates.
CPT 99382 has a total RVU of 3.45, broken down as: Work RVU 1.92, Practice Expense RVU 1.41, and Malpractice RVU 0.12. RVUs (Relative Value Units) determine Medicare reimbursement rates.
The most common denial reason for CPT 99382 is "Age doesn't match code range - early childhood 1-4 years". 99382 is for new patient preventive visits, early childhood (ages 1-4 years). Denied when patient is under 1 year (use 99381) or 5+ years (use 99383 for 5-11, 99384 for 12-17). Age boundaries strictly enforced. Particular attention to children at age boundaries (just turned 1, just turned 5). Common causes include: Child under 1 year - should be 99381; Child 5 years or older - should be 99383 or 99384. Appeal success rate is approximately 70-80%.
Key documentation requirements for CPT 99382 include: Comprehensive age and gender-appropriate history; Complete physical examination; Anticipatory guidance and risk factor counseling; Appropriate preventive screening orders. Missing or incomplete documentation is a leading cause of claim denials for this code.
Bundling considerations for CPT 99382: Cannot be billed with new patient preventive codes (99382-99387). Can be billed with problem-based E/M using modifier 25 if significant problem addressed Use an NCCI bundling checker to verify specific code combinations before billing.
Common modifiers for CPT 99382 include: 25 (Significant, separately identifiable E/M for problem-based visit on same day), 33 (Preventive services (often not required, payer-specific)). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.
The typical time requirement for CPT 99382 is Typically 30-40 minutes for comprehensive preventive visit. Time-based codes require documentation of the actual time spent providing the service.