Healthcare Insights
Top 10 preventive medicine CPT codes
Preventive medicine is a type of medicine that protects patients and communities from avoidable disability, illness, and death. Healthcare providers offer testing, counseling, and immunizations to prevent illness and identify potential health concerns as they emerge.
Preventive medicine is a vital component of healthcare because it promotes overall wellness, reduces the occurrence of illness, and saves resources.
Using data from the Atlas All-Payor Claims Database, we compiled a list of the top 10 preventive medicine CPT codes below.
| Rank | HCPCS/CPT code | HCPCS/CPT description | % total procedures | % total charges | Explore dataset |
|---|---|---|---|---|---|
| 1 | 99396 | Preventive visit for an established patient between ages 40-64 | 20.60% | 24.50% | Explore |
| 2 | 99395 | Preventive visit for an established patient between ages 18-39 | 12.90% | 14.20% | Explore |
| 3 | 99392 | Preventive visit for an established patient between ages 1-4 | 11.80% | 10.90% | Explore |
| 4 | 99391 | Preventive visit for an established patient or infant relevant to age and gender | 10.70% | 9.30% | Explore |
| 5 | 99393 | Preventive visit for an established patient between ages 5-11 | 10.50% | 9.80% | Explore |
| 6 | 99394 | Preventive visit for an established patient between ages 12-17 | 8.50% | 8.60% | Explore |
| 7 | 99397 | Preventive visit for an established patient ages 65+ | 4.60% | 5.50% | Explore |
| 8 | 99385 | Preventive visit for a new patient ages 18-39 | 4.00% | 5.20% | Explore |
| 9 | 99386 | Preventive visit for a new patient between ages 40-64 | 3.10% | 4.50% | Explore |
| 10 | 99401 | 15 minutes of preventive counseling related to patient’s age, family history, and areas of concern | 2.60% | 0.90% | Explore |
Fig. 1 Data is from the Definitive Healthcare Atlas All-Payor Claims Database and represents procedure claims for January – December 2022. Data is accurate as of February 2023.
What was the top preventive medicine CPT code in 2022?
The top preventive medicine CPT code was 99396, a preventive visit for an established patient between ages 40 and 64, representing over 20% of all preventive medicine claims and nearly a quarter of total charges in 2022.
The 40-64 age group is particularly susceptible to conditions like breast cancer, colon cancer, and osteoporosis. Preventive services are especially valuable to patients who face greater risk of illness, whether due to age, comorbidities, lifestyle, or other factors.
The table above also indicates that nearly 80% of preventive medicine claims were for established patients versus new patients. This breakdown shows that most preventive medicine services are for patients who have already received care from the provider.
Why do many people forgo preventive care?
Without health insurance, medical care can be costly and difficult to navigate. For this reason, individuals who do not have health insurance often forgo preventive care. A Bankrate survey found that in 2020, 32% of families in the U.S. did not seek medical care in the past 12 months due to cost.
A study from the CDC found four influencers of preventive care. First, and most prominently, was finances, followed by the use of metrics driving change in the healthcare system, and the role of healthcare payors. The final influencing factor was changes in healthcare reimbursement models.
Individuals who do not receive preventive care are at increased risk for disabilities, diseases, and death.
What is a CPT code?
The Current Procedural Terminology (CPT) is a system of codes used for reporting healthcare services and medical procedures. CPT codes increase the efficiency and accuracy of healthcare reporting and billing.
Definitive Healthcare tracks many CPT codes across diagnostic, medical, and surgical areas. This information can give you insight into diagnosis, procedure, and prescribing activity and transform your sales and marketing strategies.
Learn more
To hear more about the long-term implications of pandemic-related delays in care, including preventive care, listen to our podcast with Dr. Mark Pimentel.
Healthcare Insights are developed with healthcare commercial intelligence from the Definitive Healthcare platform. Want even more insights? Start a free trial now and get access to the latest healthcare commercial intelligence on hospitals, physicians, and other healthcare providers.
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