Just as primary care is the bedrock of patient health, accurate Current Procedural Terminology (CPT) coding is crucial for the financial health of your practice. Errors in CPT coding can lead to rejected claims and lost revenue. In primary care, where a wide array of services are provided, mastering CPT codes is essential. Primary care physicians handle everything from routine check-ups to managing complex health conditions, making the coding process intricate. Translating these diverse services into the correct five-digit CPT codes can feel overwhelming.
With a vast landscape of CPT codes covering common primary care services—including routine office visits, essential diagnostic tests, comprehensive wellness exams, preventative care measures, vital vaccinations, therapeutic procedures, and specialized care—it’s easy for even seasoned practitioners to feel lost.
Fortunately, this guide breaks down the most frequently used primary care CPT codes for 2024, providing clarity and confidence in your coding practices.
Top CPT Codes for Primary Care Evaluation and Management (E/M) Visits
Evaluation and Management (E/M) visits form the core of primary care. These codes are used for office visits with both new and established patients and are categorized based on the complexity of the medical decision-making and the time spent with the patient.
CPT Codes 99202-99205: E/M Visits for New Patients
When a primary care provider sees a patient for the first time, codes 99202-99205 are utilized. These codes differentiate visits based on the level of medical decision-making required, ranging from straightforward to high complexity.
| CPT Code | Description | Time Guidelines |
|---|---|---|
| 99202 | Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. | 15 minutes |
| 99203 | Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. | 30 minutes |
| 99204 | Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. | 45 minutes |
| 99205 | Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. | 60 minutes |
Example: A new patient presents with symptoms suggestive of a common cold. The physician takes a detailed history, performs a physical exam, and diagnoses an upper respiratory infection, recommending rest and fluids. This straightforward case might be coded as 99202. Conversely, a new patient with multiple comorbidities presenting for a comprehensive evaluation and requiring a complex treatment plan would likely be coded with 99205.
CPT Codes 99211-99215: E/M Visits for Established Patients
For established patients, codes 99211-99215 are used for E/M visits. These codes also vary based on medical decision-making complexity and visit duration, but also include a code (99211) for visits that may not always require a physician.
| CPT Code | Description | Time Guidelines |
|---|---|---|
| 99211 | Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. | 5 minutes |
| 99212 | Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. | 10 minutes |
| 99213 | Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. | 20 minutes |
| 99214 | Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. | 30 minutes |
| 99215 | Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. | 40 minutes |
Example: An established patient comes in for a routine blood pressure check and medication refill. If this visit is handled primarily by clinical staff, it might be coded as 99211. An established patient with well-managed hypertension presents for a routine follow-up, requiring minimal medication adjustments; this could be coded as 99213. An established patient with poorly controlled diabetes and new symptoms requiring significant treatment plan adjustments would likely be coded as 99215.
Essential Primary Care CPT Codes for Immunizations
Vaccinations are a cornerstone of preventive care in primary practice. Accurate coding for vaccines ensures proper reimbursement and tracks crucial public health data.
CPT Codes 91318-91322: COVID-19 Immunization Codes
COVID-19 vaccinations remain a vital part of primary care. CPT codes 91318-91322 specifically address different formulations and dosages of the Pfizer and Moderna COVID-19 vaccines, categorized by patient age and vaccine type.
| CPT Code | Description | Product | Dosage | Age Group |
|---|---|---|---|---|
| 91318 | SARS-COV-2 vaccine, mRNA, LNP-S, PF, preservative free, tris-sucrose formulation, 3 mcg/0.2 mL dosage, diluent reconstituted, for intramuscular use | Pfizer-BioNTech | 3 mcg/0.2 mL | 6 months–4 years |
| 91319 | SARS-COV-2 vaccine, mRNA, LNP-S, PF, preservative free, tris-sucrose formulation, 10 mcg/0.2 mL dosage, diluent reconstituted, for intramuscular use | Pfizer-BioNTech | 10 mcg/0.2 mL | 5–11 years |
| 91320 | SARS-COV-2 vaccine, mRNA, LNP-S, PF, preservative free, tris-sucrose formulation, 30 mcg/0.3 mL dosage, diluent reconstituted, for intramuscular use | Pfizer-BioNTech | 30 mcg/0.3 mL | 12 years and older |
| 91321 | SARS-COV-2 vaccine, mRNA, LNP-S, PF, preservative free, 25 mcg/0.25 mL dosage, for intramuscular use | Moderna | 25 mcg/0.25 mL | 6 months–11 years |
| 91322 | SARS-COV-2 vaccine, mRNA, LNP-S, PF, preservative free, 50 mcg/0.5 mL dosage, for intramuscular use | Moderna | 50 mcg/0.5 mL | 12 years and older |
Note: Always verify the most current CPT code updates, as vaccine codes can change frequently, especially during public health emergencies.
CPT Codes 90736 & 90750: Shingles Immunization Codes
Shingles vaccination is recommended for adults 50 and older to prevent the painful condition caused by the reactivation of the varicella-zoster virus. Codes 90736 and 90750 represent different types of shingles vaccines.
- CPT Code 90736: Zoster vaccine (shingles), live, for subcutaneous injection. This code is for the older, live attenuated shingles vaccine (Zostavax).
- CPT Code 90750: Zoster vaccine (shingles), recombinant, subunit, adjuvanted, for intramuscular injection. This code is for the newer, recombinant zoster vaccine (Shingrix), which is preferred due to higher efficacy and is given in two doses.
CPT Codes 90649 & 90651: HPV Immunization Codes
Human Papillomavirus (HPV) vaccination is crucial for preventing HPV-related cancers and is recommended for adolescents and young adults.
- CPT Code 90649: Human Papillomavirus vaccine, quadrivalent (types 6, 11, 16, 18), recombinant, 3 dose schedule, for intramuscular injection. This code is for a quadrivalent HPV vaccine.
- CPT Code 90651: Human Papillomavirus vaccine, 9-valent, recombinant, 2 dose schedule for children 9-14 years of age at initial vaccination, 3 dose schedule for individuals 15 years of age and older at initial vaccination, for intramuscular injection. This code represents the 9-valent HPV vaccine, which offers broader protection against more HPV strains.
CPT Codes 90678, 90679, & 90683: RSV Immunization Codes
Respiratory Syncytial Virus (RSV) vaccines are now recommended for older adults (60+) and infants/young children, as well as pregnant women to protect their babies.
- CPT Code 90678: Respiratory syncytial virus vaccine, subunit, bivalent f protein, prefusion, for intramuscular injection.
- CPT Code 90679: Respiratory syncytial virus vaccine, subunit, prefusion f protein, adjuvanted, for intramuscular injection.
- CPT Code 90683: Respiratory syncytial virus vaccine, mRNA, lipid nanoparticles, preservative free, for intramuscular injection.
These codes differentiate between different RSV vaccine formulations and target populations. Ensure you select the correct code based on the vaccine administered and patient demographics.
CPT Codes 90702, 90714, & 90715: Tdap Immunization Codes
Tetanus, Diphtheria, and Pertussis (Tdap) vaccination is recommended for adults and adolescents to protect against these serious bacterial infections. Booster doses are recommended every 10 years.
- CPT Code 90702: Tetanus, diphtheria, acellular pertussis vaccine (Tdap), for intramuscular use; <7 years. This code is for Tdap vaccines administered to children under 7 years old.
- CPT Code 90714: Tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap), preservative free, for intramuscular use; ≥7 years. This code is for preservative-free Tdap vaccines for patients 7 years and older.
- CPT Code 90715: Tetanus, diphtheria and acellular pertussis vaccine (Tdap), for intramuscular use; ≥7 years. This is a general code for Tdap vaccines for patients 7 years and older.
Common Primary Care CPT Codes for Preventive Care Services
Preventive care is a cornerstone of primary care, encompassing a range of services aimed at maintaining health and preventing disease.
CPT Codes 99381-99387: Preventive Medicine Visits for New Patients
Codes 99381-99387 are used for comprehensive preventive medicine evaluations for new patients, often referred to as “well-patient visits.” These codes are age-specific, covering different age ranges from infancy to older adulthood.
| CPT Code Range | Description | Age Range |
|---|---|---|
| 99381 | Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; | Infant (younger than 1 year) |
| 99382 | Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; | Early childhood (age 1 through 4 years) |
| 99383 | Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; | Late childhood (age 5 through 11 years) |
| 99384 | Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; | Adolescent (age 12 through 17 years) |
| 99385 | Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; | 18-39 years |
| 99386 | Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; | 40-64 years |
| 99387 | Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; | 65 years and older |
CPT Codes 99391-99397: Preventive Medicine Visits for Established Patients
CPT codes 99391-99397 are used for periodic preventive medicine re-evaluations and management for established patients, also known as “annual physicals” or “wellness visits.” Similar to the new patient codes, these are also age-specific.
| CPT Code Range | Description | Age Range |
|---|---|---|
| 99391 | Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; | Infant (younger than 1 year) |
| 99392 | Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; | Early childhood (age 1 through 4 years) |
| 99393 | Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; | Late childhood (age 5 through 11 years) |
| 99394 | Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; | Adolescent (age 12 through 17 years) |
| 99395 | Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; | 18-39 years |
| 99396 | Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; | 40-64 years |
| 99397 | Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; | 65 years and older |
CPT Codes 99401-99429: Preventive Medicine Counseling and Interventions
Codes 99401-99429 cover counseling and risk factor reduction interventions provided to individuals and groups. These codes encompass a range of preventive medicine services, including individual and group counseling, and telehealth services.
| CPT Code Range | Category | Description |
|---|---|---|
| 99401 – 99404 | Individual Counseling | These codes are time-based and used for individual counseling sessions ranging from 15 to 60 minutes, focusing on health management, risk factor reduction, and preventive measures. |
| 99406 – 99409 | Behavior Change Interventions, Individual | These codes are used for brief (10-30 minute) individual behavior change interventions, such as smoking cessation counseling or alcohol misuse screening and intervention. |
| 99411 – 99412 | Group Counseling | These codes are time-based and used for group counseling sessions focusing on health and wellness topics. |
| 99421 – 99429 | Other Preventive Medicine Services | This range includes codes for telehealth preventive medicine services and for care management services for patients with complex chronic conditions. Telehealth codes are time-based and can cover services lasting up to 7 days. |
Frequently Used Primary Care CPT Codes for Laboratory Tests
Laboratory tests are integral to primary care for diagnosis, monitoring, and managing patient health. Familiarity with common lab test CPT codes is crucial for accurate billing.
CPT Code 85025: Complete Blood Count (CBC)
CPT code 85025 represents a Complete Blood Count (CBC), a fundamental hematology test ordered frequently in primary care. A CBC provides information about different blood cell types and is used to diagnose a wide range of conditions, from infections to anemia and blood disorders.
This code covers the venipuncture (blood draw) and the automated analysis of the blood sample in the lab.
CPT Code 80048: Basic Metabolic Panel (BMP)
CPT code 80048 is for a Basic Metabolic Panel (BMP), a common chemistry panel used to assess a patient’s general health status, particularly kidney function, electrolyte balance, and blood glucose levels. It includes tests for calcium, electrolytes (sodium, potassium, chloride, carbon dioxide), glucose, BUN, and creatinine.
CPT Code 80061: Lipid Panel
CPT code 80061 represents a Lipid Panel, used to assess a patient’s risk for cardiovascular disease. It typically includes total cholesterol, triglycerides, HDL cholesterol, and LDL cholesterol (calculated). This is a bundled code encompassing multiple individual lipid tests.
CPT Code 84436: Thyroid Stimulating Hormone (TSH)
CPT code 84436 is for a Thyroid Stimulating Hormone (TSH) test, a common thyroid function test used to screen for and monitor thyroid disorders, such as hypothyroidism and hyperthyroidism. TSH is a key indicator of thyroid gland function.
Common Primary Care CPT Codes for Special Care Services
Primary care practices also provide a range of special care services, including diagnostic procedures and treatments for various patient populations.
CPT Code 93303: Transthoracic Echocardiography, Complete
CPT code 93303 is used for a complete transthoracic echocardiogram, a non-invasive ultrasound of the heart. In primary care, it might be ordered to evaluate heart murmurs, chest pain, or symptoms suggestive of heart failure. This code includes both the technical component (performing the echocardiogram) and the professional component (interpretation and report).
CPT Code 99177: Vision Screening, Automated
CPT code 99177 describes an automated vision screening, often performed in primary care settings, especially for children and adolescents. This code is used for bilateral screening and includes both technical and professional components.
CPT Code 94640: Inhalation Treatment, Aerosol
CPT code 94640 is used for inhalation treatments, such as nebulizer treatments, often administered in primary care offices to patients experiencing respiratory distress from conditions like asthma or COPD exacerbations. This code covers the administration of the aerosolized medication.
Conclusion: Mastering Primary Care CPT Coding for Practice Success
Navigating the complexities of CPT coding is a continuous challenge in primary care. The sheer volume of codes, frequent updates, and the need for specificity can make accurate coding feel like an uphill battle. However, precise CPT coding is not just about billing; it’s about ensuring the financial stability of your practice and enabling you to continue providing high-quality patient care.
Staying updated with the latest CPT code changes and understanding the nuances of each code is crucial. For practices struggling with coding accuracy and efficiency, outsourcing primary care billing to experienced professionals can be a strategic solution. Specialized medical billing services, like MediBillMD, employ AAPC-certified coders who are experts in Primary Care Cpt Coding, ensuring accurate claims submission and maximized reimbursements.
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