Just as you are the frontline of healthcare for your patients, accurate Current Procedural Terminology (CPT) coding is your practice’s frontline defense against medical claim denials.
Navigating CPT codes for primary care services can be challenging. Primary care physicians (PCPs) deliver a broad spectrum of services, from diagnosis to treatment and ongoing health management. The complexity of translating these services into precise 5-digit CPT codes becomes apparent when it’s time for billing and coding.
With a vast array of CPT codes covering primary care—including routine visits, diagnostic tests, wellness exams, preventive care, vaccinations, therapeutic procedures, and specialized care—it’s easy for healthcare providers to feel overwhelmed.
Fortunately, we’ve compiled a guide to the most frequently used primary care CPT codes for the current year. Let’s simplify your coding process.
Common CPT Codes for Primary Care Office Visits
The most commonly reported CPT codes in primary care for evaluation and management (E/M) services during office visits, categorized by new and established patients, are detailed below.
CPT Codes 99202-99205: Outpatient E/M Visits for New Patients
Primary care often involves evaluation and management (E/M) services conducted in outpatient settings or physician offices. These timed visits are tailored to cases with varying degrees of complexity. CPT codes 99202 through 99205 are designated for E/M visits specifically for new patients. Here’s a breakdown:
| CPT Code | Description | Duration |
|---|---|---|
| 99202 | This code is for an E/M visit where a provider meets a new patient for a face-to-face consultation, involving straightforward medical decision-making. These visits are for less complex cases and may include taking patient medical and family histories and performing detailed physical examinations. | 15 minutes or more |
| 99203 | This primary care CPT code applies to E/M visits with new patients that require a low level of medical decision-making. | 30 minutes or more |
| 99204 | Report this code when a primary care physician sees a new patient in an outpatient or office setting and engages in moderate complexity medical decision-making. | 45 minutes or more |
| 99205 | This CPT code is used for primary care visits when a provider sees a new patient and makes high-level medical decisions, such as determining treatment strategies for high-risk conditions. | 60 minutes or more |
CPT Codes 99211-99215: Outpatient E/M Visits for Established Patients
Conversely, CPT codes 99211 through 99215 are used for timed E/M services or consultations with established patients in outpatient or office settings.
These E/M visits vary in complexity of medical decision-making, depending on the established patient’s health status. Refer to the table below for detailed information.
| CPT Code | Description | Duration |
|---|---|---|
| 99211 | This primary care CPT code is reported when an established patient visits and has a face-to-face encounter with clinical staff other than the primary physician, such as a nurse practitioner (NP), physician assistant (PA), or other non-physician practitioner (NPP). Physician supervision may or may not be required. | 5 minutes or more |
| 99212 | This E/M visit code is used when the provider directly consults with an established patient and makes straightforward medical decisions. | 10 minutes or more |
| 99213 | Use this CPT code for primary care visits when a provider meets with a returning patient face-to-face and makes low-level medical decisions, such as adjusting medication dosages. | 20 minutes or more |
| 99214 | In this E/M visit with an established patient, the provider engages in moderate complexity medical decision-making, like altering a treatment plan. | 30 minutes or more |
| 99215 | This CPT code for primary care visits is for encounters involving high complexity medical decision-making for an established patient. The provider meets the patient face-to-face in an outpatient or office setting. | 40 minutes or more |
Frequently Used Vaccination CPT Codes in Primary Care
The following are the most frequently utilized CPT codes for vaccinations administered in primary care settings.
CPT Codes 91318-91322: COVID-19 Vaccine and Immunization Codes
No primary care CPT coding guide for vaccinations would be complete without addressing the COVID-19 vaccine. Since the onset of the global pandemic in 2019, the coronavirus continues to be a significant health concern. Vaccination efforts began in December 2020 and are ongoing, with recommendations for annual booster shots to maintain immunity, especially within high-risk populations.
Below is a table detailing the current year’s primary care CPT codes for COVID-19 vaccination, along with their specific descriptions.
| CPT Code | Description | Product | Dosage |
|---|---|---|---|
| 91318 | Intramuscular injection of SARS–CoV–2 vaccine product (tris–sucrose formulation) for patients aged 6 months to 4 years. | Pfizer | 3 mcg/0.2 mL |
| 91319 | Intramuscular injection of SARS–CoV–2 vaccine product (tris–sucrose formulation) for patients aged 5 to 11 years. | Pfizer | 10 mcg/0.2 mL |
| 91320 | Intramuscular injection of SARS–CoV–2 vaccine product (tris–sucrose formulation) for patients aged 12 years and older. | Pfizer | 30 mcg/0.3 mL |
| 91321 | Intramuscular administration of SARS–CoV–2 mRNA-LNP vaccine product for patients aged 6 months to 11 years. | Moderna | 25 mcg/0.25 mL |
| 91322 | Intramuscular administration of SARS–CoV–2 mRNA-LNP vaccine product for patients aged 12 years and older. | Moderna | 50 mcg/0.5 mL |
CPT Codes 90736 and 90750: Shingles Vaccine Codes
CPT codes 90736 and 90750 are used when coding for shingles vaccinations for healthy adults aged 50 and over. Shingles, caused by the varicella-zoster virus, is a painful skin rash that occurs when the chickenpox virus reactivates in adults who have had chickenpox previously. It often includes nerve pain but is generally not life-threatening.
CPT code 90736 is for subcutaneous injections of a live shingles vaccine. Code 90750 is for intramuscular injections of an adjuvanted shingles vaccine, which enhances the immune response.
CPT Codes 90649 & 90651: Human Papillomavirus (HPV) Vaccine Codes
In the United States, HPV vaccination is most common among adults aged 18 to 26, though vaccination can start as early as ages 11 and 12 for both girls and boys. According to the CDC, HPV is the most common sexually transmitted infection in the U.S. and can lead to various cancers, including cervical, anal, and oral cancers.
Primary care CPT code 90649 is used to report intramuscular injection of a quadrivalent HPV vaccine, protecting against four HPV types, typically administered in a 3-dose series.
CPT code 90651 is used for intramuscular injection of a nonavalent HPV vaccine, which protects against nine HPV strains and is also administered in two or three doses.
CPT Codes 90678, 90679, & 90683: Respiratory Syncytial Virus (RSV) Vaccine Codes
For adults aged 60 and older, RSV vaccination is recommended to prevent respiratory infections. CPT codes 90679, 90678, and 90683 are used for coding RSV vaccinations.
Code 90678 is for intramuscular injection of a bivalent prefusion F vaccine. CPT code 90679 is for intramuscular injection of a prefusion F (preF) vaccine with an adjuvant to improve immune response against RSV.
CPT code 90683 is used for intramuscular injection of an mRNA vaccine like Moderna’s mRESVIA (0.5 mL syringe) to prevent RSV. This mRNA vaccine uses lipid nanoparticles to deliver its protection.
CPT Codes 90702, 90714, & 90715: Tetanus, Diphtheria, & Pertussis (Tdap) Vaccine Codes
CPT codes 90702, 90714, and 90715 are used to code for Tetanus, Diphtheria, and Pertussis (Tdap) vaccinations with high specificity. The CDC recommends Tdap vaccination for everyone aged 7 and older, with a booster needed every 10 years.
This 3-in-1 vaccine protects against pertussis (whooping cough), diphtheria (breathing difficulties), and tetanus (lockjaw).
CPT code 90702 indicates intramuscular administration of a Tdap vaccine to patients under 7 years old. Code 90714 is for preservative-free Tdap vaccine intramuscularly administered to patients over 7 years old. CPT code 90715 is for a Tdap booster dose in patients 7 years and older.
Frequently Used Preventive Care CPT Codes in Primary Care
Primary care providers offer a range of preventive services, including lifestyle counseling, routine check-ups and screenings, annual flu shots, interventional treatments, and chronic disease management.
These preventive care services are delivered in person or via telehealth and are coded using specific primary care CPT codes for both new and established patients.
CPT Codes 99381-99387: Preventive Care Visits for New Patients
CPT codes 99381 through 99387 are used to report preventive care visits for new patients. These visits are essential for primary care and encompass comprehensive wellness examinations, consultations, and health management counseling.
This range covers new patients from infants under one year old to adults aged 65 and older. These visits are commonly referred to as “well-patient visits.”
CPT Codes 99391-99397: Preventive Care Visits for Established Patients
CPT codes 99391 to 99397 cover well-patient visits and routine physical check-ups for established patients. These preventive visits are often annual and non-urgent. They focus on the patient’s gender, age, and risk factors to provide effective preventive care, rather than addressing immediate medical concerns.
In addition to reviewing past, family, and social history (PFSH), physicians may order lab tests for screening purposes. These CPT codes for preventive visits with established patients are also age-specific, covering patients from age 5 (code 99393) to adults 65 and older (code 99397).
CPT Codes 99401-99429: Preventive Medicine Counseling and Intervention Codes
This CPT code range covers individual and group counseling and interventions for behavior change for both new and established patients at risk of developing health conditions.
CPT codes 99401-99429 also include additional preventive medicine services, such as telehealth consultations for health management. Telehealth CPT codes are time-based and can cover services lasting up to 7 days.
| CPT Code Range | Category | General Description |
|---|---|---|
| 99401 – 99404 | Preventive Medicine, Individual Counseling | This range covers 15-60 minutes of one-on-one counseling on health management based on patient age, family history, and physical condition. Physicians assess risk factors and suggest preventive measures. |
| 99406 – 99409 | Behavior Change Interventions, Individual | These codes are for behavior change interventions with a single patient lasting 10-30 minutes. Services include counseling for tobacco cessation or screening for alcohol or substance abuse with brief intervention. |
| 99411 – 99412 | Preventive Medicine, Group Counseling | CPT codes 99411 and 99412 are for time-based group counseling sessions focused on maintaining and improving physical health. |
| 99421 – 99429 | Other Preventive Medicine Services | This range is used for billing timed telehealth sessions for health management or when a provider delivers care plan oversight services to a patient with a complex chronic condition. |
Most Common Lab Test CPT Codes in Primary Care
Primary care physicians frequently order lab tests to diagnose and monitor various health conditions. Familiarity with CPT codes for common lab tests, such as blood, thyroid, and lipid panel tests, is crucial.
CPT Code 85025: Complete Blood Count (CBC) Blood Test Code
CPT code 85025, within hematology and coagulation procedures, represents a complete blood count (CBC).
Ordered by primary care providers, a CBC measures red blood cells, white blood cells, platelets, and hemoglobin levels. Additional metrics like hematocrit, mean corpuscular volume (MCV), and mean corpuscular hemoglobin concentration (MCHC) are also included. This comprehensive count of seven blood cell types aids in diagnosing conditions like infections, anemia, and leukemia.
CPT code 85025 is reported when a lab technician draws blood, usually venous, into a labeled tube with anticoagulant (EDTA or citrate) for lab analysis. Automated analyzers in the lab count blood cell types, and a report is generated for the ordering physician.
CPT Code 80048: Basic Metabolic Panel (BMP) Test Code
CPT code 80048 is another frequently used code for primary care lab tests. The basic metabolic panel (BMP) assesses a patient’s general health, focusing on kidney function, electrolyte balance, and fluid balance.
Reporting CPT code 80048 indicates a blood test measuring eight substances: calcium, potassium, sodium, glucose, carbon dioxide, creatinine, chloride, and blood urea nitrogen (BUN).
CPT Code 80061: Comprehensive Lipid Panel Test Code
Primary care physicians may order a lipid panel test to assess a patient’s risk of coronary heart disease or stroke.
CPT code 80061 is a bundled code for a lipid panel, including measurements of total cholesterol (code 82465), triglycerides (code 84478), and HDL cholesterol (code 83718).
The lipid panel test is a blood test performed by a qualified lab technician or pathologist.
CPT Code 84436: Thyroid Function Test Code
A thyroid function test is used to evaluate thyroid disorders or underactive thyroid glands. Thyroid issues can cause symptoms like mood changes, fatigue, weight changes, and anxiety, and increase heart disease risk. Physicians recommend thyroid tests when these symptoms are present.
CPT code 84436 is specifically for blood tests measuring thyroxine (T4) levels, a hormone produced by the thyroid gland that regulates growth and development. Blood is drawn and sent to the lab for analysis.
Common Special Care CPT Codes in Primary Care
Primary care physicians also address specific healthcare needs, offering diagnostic imaging, screenings, and therapeutic procedures for patients of all ages and genders.
Special care services in primary practices range from infant care to geriatric care and prenatal services. Here are some commonly used special care CPT codes in primary care.
CPT Code 93303: Complete Transthoracic Echocardiography Code
Approximately eight in every 1,000 infants in the U.S. are born with a congenital heart defect (CHD). CHDs can cause symptoms like shortness of breath, palpitations, fatigue, and cyanosis.
When these symptoms are detected, a primary care provider may order a complete transthoracic echocardiography to examine the heart’s structure. CPT code 93303 is reported when echocardiography is used to image heart structures, including chambers, walls, and valves, and to assess cardiac activity and blood flow. Code 93303 covers both the technical and professional components of this procedure.
CPT Code 99177: Bilateral Eye Screening Code
CPT code 99177 is frequently used in primary care for vision tests or screenings. Primary care physicians use this code to bill for bilateral eye screenings.
The physician uses instruments to examine both eyes for ocular diseases. This service includes both technical and professional components, as the screening and interpretation occur during the same session and on-site.
CPT Code 94640: Nebulizer Treatment Code
CPT code 94640 is used when physicians administer nebulizer treatments for airway obstruction.
For patients with asthma attacks or chronic lung diseases experiencing breathing difficulties, physicians may provide pressurized or non-pressurized inhalation treatments to open blocked airways. This procedure can also be used for sputum induction for lab analysis.
Conclusion
Coding can be one of the most challenging aspects of medical billing across all specialties. Primary care CPT codes cover a wide array of diagnoses, visits, treatments, and procedures. Precisely applying these codes can be complex, even with a cheat sheet.
Even when familiar with the most common primary care CPT codes for the year, annual revisions require constant updates to avoid using outdated codes. If you find coding overwhelming, help is available. Our primary care billing services offer accurate CPT coding performed by AAPC-certified coders, ensuring your claims are correctly processed and reimbursed.
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