What is the recommended time allocation for CPT (Current Procedural Terminology) 99396?

Time Allocation for CPT 99396

For CPT code 99396 (established patient preventive medicine service for ages 40-64), the recommended time allocation is typically 40 minutes face-to-face with the patient.

Understanding CPT 99396 Time Requirements

CPT 99396 is a preventive medicine service code for established patients aged 40-64 years. While the CPT manual does not explicitly assign specific times to preventive medicine codes, the following guidelines apply:

• Preventive medicine codes like 99396 are comprehensive in nature, requiring:
  • A comprehensive age and gender-appropriate history
  • A comprehensive examination
  • Counseling/anticipatory guidance
  • Risk factor reduction interventions
  • Ordering of appropriate immunizations and laboratory/diagnostic procedures

Documentation Requirements

• The visit must be clearly documented as a comprehensive preventive service
• Documentation should reflect the comprehensive nature of the visit
• If addressing a significant, separately identifiable problem during the same visit:
  • Document the problem-oriented service separately
  • Use modifier 25 with the appropriate E/M code (e.g., 99214-25) 1, 2

Comparison with Other E/M Services

When comparing 99396 with problem-oriented E/M services:

• 99214 typically requires 25 minutes face-to-face time (when >50% is spent counseling) 1, 2
• 99215 typically requires 40 minutes face-to-face time (when >50% is spent counseling) 1
• 99396 (preventive) is more comprehensive than these problem-oriented visits

Practical Time Management Considerations

Research shows that time management in primary care is challenging:

• Primary care physicians often experience significant time constraints 3, 4
• The median visit length in primary care is approximately 15.7 minutes 4
• For comprehensive preventive services like 99396, more time is needed than for routine visits

Billing and Coding Best Practices

• When both preventive and problem-oriented services are provided on the same day:

  • Bill the preventive service code (99396) for the wellness component
  • Add the appropriate E/M code with modifier 25 for the problem-oriented component
  • Document both services separately 2

• Insurance typically covers preventive services at 100%, while problem-oriented services may be subject to copays/deductibles 2

Common Pitfalls to Avoid

• Insufficient documentation of the comprehensive nature of the preventive visit
• Failure to use modifier 25 when billing both preventive and problem-oriented services
• Inadequate time allocation for comprehensive preventive services

By allocating approximately 40 minutes for CPT 99396 visits, providers can ensure adequate time for comprehensive preventive care while maintaining appropriate documentation and billing practices.