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Fam Pract Manag. 2000;7(2):19

Preventive medicine services revisited

Since I stated in the October 1999 issue that it was inappropriate from a CPT perspective to use a -52, “Reduced Services,” modifier with a preventive medicine services code to code an abbreviated screening visit, such as a sports physical, I have received numerous inquiries asking for further explanation. Here it is: According to CPT, “The ‘comprehensive’ examination of the Preventive Medicine Services codes 99381-99397 is not synonymous with the ‘comprehensive’ examination required in Evaluation and Management codes 99201-99350.” CPT does not specify the requirements for a comprehensive exam provided as part of a preventive medicine service, but does say, “The extent and focus of the services will largely depend on the age of the patient.” Consequently, each preventive medicine services code is, in a sense, elastic enough to encompass a range of services such that a reduced services modifier does not make sense in this context. I consulted with the AMA's Department of Coding and Nomenclature, which develops CPT, and they confirmed this interpretation.

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Send questions and comments to, or add your comments below. While this department attempts to provide accurate information, some payers may not accept the advice given. Refer to the current CPT and ICD-10 coding manuals and payer policies.

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