Top 10 preventive medicine CPT codes in 2021 

Preventive medicine is a vital component of healthcare because it promotes health, reduces illnesses and saves costs.  

What was the top preventive medicine CPT code in 2021? 

The top preventive medicine CPT code was 99396, a preventive visit for an established patient between ages 40 and 64. This code had a total number of procedures of 10,589,943, equating to $2,621,658,243 in charges. CPT code 99396 had 61% more procedures than the second preventive CPT code, 99395.  

It makes sense that this code tops the list since the 40-64 age group is particularly susceptible to conditions like breast cancer, colon cancer and osteoporosis. Preventive services can help protect individuals in this age group from these illnesses.  

We compiled a list of the top 10 preventive medicine CPT codes below. 

Top 10 CPT codes in preventive medicine  

Rank 

CPT Code 

CPT Description 

# Total Procedures 

Total Charges 

99396 

Preventive visit for an established patient between ages 40-64 

10,589,943 

$2,621,658,243  

99395 

Preventive visit for an established patient between ages 18-39 

6,562,895 

$1,503,481,221  

99392 

Preventive visit for an established patient between ages 1-4 

6,201,444 

$1,178,700,764  

99391 

Preventive visit for an established patient or infant relevant to age and gender  

5,582,344 

$1,005,129,194  

99393 

Preventive visit for an established patient between ages 5-11 

5,527,628 

$1,142,332,298  

99394 

Preventive visit for an established patient between ages 12-17 

4,502,373 

$942,500,624  

99397 

Preventive visit for an established patient ages 65+ 

2,215,432 

$552,295,153  

99385 

Preventive visit for a new patient ages 18-39 

2,013,016 

$541,644,900  

99386 

Preventive visit for a new patient between ages 40-64 

1,594,261 

$470,166,497  

10 

99401 

15 minutes of preventive counseling related to patient’s age, family history, and areas of concern 

1,303,081 

$92,495,471 

Fig. 1Data is from the Definitive Healthcare ClaimsMx product. Data is accurate as of March 2022. 

The total number of procedures of the top ten preventive medicine CPT codes was 46,092,417. The average number of procedures across the top ten preventive medicine CPT codes was 4,609,242. The total number of charges of the top ten preventive medicine CPT codes was $10,050,404,365. The average number of charges across the top ten preventive medicine CPT codes was $1,005,040,437. 

The table above also indicates 89% of the preventive medicine CPT codes were for established patients versus new patients. This breakdown is interesting, as it shows that most preventive medicine services are for patients who have already received care from the provider.  

The tenth preventive medicine CPT code was the lowest, with 1,303,081 total procedures and $92,495,471 total charges. This is significantly lower than the other top ten preventive medicine CPT codes. This may be because it is not defined by an age range, unlike the other top 9 codes. It’s usually preferable to match patients’ age to the CPT code with the correct age range.  

What is preventive medicine?  

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 as part of preventative medicine. 

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, finances. Second, use of metrics driving change in the healthcare system. Third, the role of healthcare payors. And last, rapid 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? 

A CPT code is a code within the Current Procedural Terminology (CPT) 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.

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