Initial preventive medicine, age 65 years and older, established patient
Audit Defense & Denial Intelligence
Research-based denial patterns from OrbDoc Bill Analyzer
1. Age doesn't match code range - adolescent 12-17 years
Very Common99384 is for new patient preventive visits, adolescent (ages 12-17 years). Denied when patient is under 12 years (use 99383) or 18+ years (use adult codes 99385-99387). Common at age 17-18 boundary when teen turns 18 before visit date, requiring adult preventive code instead.
Common Causes
- • Patient under 12 years - should be 99383
- • Patient 18 years or older - should use adult code (99385, 99386, or 99387)
- • Visit scheduled as teen but occurred after 18th birthday
Resolution Strategy
Verify age at visit. If 12-17, appeal with documentation. If 18+, correct to adult preventive code (99385 for new patient 18-39, 99386 for 40-64, 99387 for 65+) and resubmit.
Relative Value Units (RVUs)
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Clinical Information
When to Use
Comprehensive preventive medicine evaluation for established patients age 65 and older
Common Scenarios
Documentation Requirements
- Comprehensive geriatric history including functional status
- Complete physical examination with attention to mobility and cognition
- Age-appropriate cancer and disease screening
- Fall risk assessment and prevention counseling
- Advance care planning discussion documentation
Coding Guidelines
Common Modifiers
Bundling Rules
- Cannot be billed for Medicare patients (use G0438/G0439 instead)
- Can be billed with problem-based E/M using modifier 25
- Includes comprehensive geriatric assessment elements
Exclusions
- G0438-G0439 (Medicare Annual Wellness Visit - use for Medicare beneficiaries)
- 99201-99215 (problem-based office visits without modifier 25)
- 99394-99397 (new patient preventive codes)
Coding Notes
Clinical scenarios
- Comprehensive geriatric history including functional status
- Complete physical examination with attention to mobility and cognition
- Age-appropriate cancer and disease screening
- Comprehensive geriatric history including functional status
- Complete physical examination with attention to mobility and cognition
- Age-appropriate cancer and disease screening
- Comprehensive geriatric history including functional status
- Complete physical examination with attention to mobility and cognition
- Age-appropriate cancer and disease screening
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Frequently Asked Questions
CPT 99384 is the billing code for "Initial preventive medicine, age 65 years and older, established patient". Comprehensive preventive medicine evaluation for established patients age 65 and older
Medicare pays approximately $129.71 for CPT 99384 (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 99384 has a total RVU of 4.32, broken down as: Work RVU 2.40, Practice Expense RVU 1.77, and Malpractice RVU 0.15. RVUs (Relative Value Units) determine Medicare reimbursement rates.
The most common denial reason for CPT 99384 is "Age doesn't match code range - adolescent 12-17 years". 99384 is for new patient preventive visits, adolescent (ages 12-17 years). Denied when patient is under 12 years (use 99383) or 18+ years (use adult codes 99385-99387). Common at age 17-18 boundary when teen turns 18 before visit date, requiring adult preventive code instead. Common causes include: Patient under 12 years - should be 99383; Patient 18 years or older - should use adult code (99385, 99386, or 99387). Appeal success rate is approximately 70-80%.
Key documentation requirements for CPT 99384 include: Comprehensive geriatric history including functional status; Complete physical examination with attention to mobility and cognition; Age-appropriate cancer and disease screening; Fall risk assessment and prevention counseling. Missing or incomplete documentation is a leading cause of claim denials for this code.
Bundling considerations for CPT 99384: Cannot be billed for Medicare patients (use G0438/G0439 instead). Can be billed with problem-based E/M using modifier 25 Use an NCCI bundling checker to verify specific code combinations before billing.
Common modifiers for CPT 99384 include: 25 (Significant, separately identifiable E/M for problem-based visit on same day), 33 (Preventive services (payer-specific)). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.
The typical time requirement for CPT 99384 is Typically 45-60 minutes for comprehensive geriatric preventive visit. Time-based codes require documentation of the actual time spent providing the service.