CPT 99394: Preventive Visit, Established Patient, Age 12-17
Periodic comprehensive preventive medicine reevaluation and management of an established patient, age 12 through 17 years.
Why CPT 99394 Claims Get Denied
Claims billed under CPT 99394 are frequently denied or downcoded for the following reasons. Understanding these patterns helps your practice reduce denial rates and recover revenue faster.
Annual visit already used in benefit period
Sports physical not separately billable
Diagnosis code not supporting preventive visit
Same-day E/M bundling issues
Billing Tips for CPT 99394
Document all risk assessments for adolescents. Bill HPV, Tdap, and meningococcal vaccines separately. If combining with a problem-focused visit, use modifier 25 on the preventive code.
Documentation Requirements
To support a clean claim for CPT 99394, your clinical documentation should include:
Updated history with psychosocial assessment
Complete physical examination
Depression screening (PHQ-A)
Substance use screening
Sexual health assessment as appropriate
Immunization review and administration
Common Modifiers for CPT 99394
Reduce CPT 99394 Denials by 60%
RediClaim's pre-submission scrubber catches documentation gaps and coding errors before you submit, while the appeal generator handles denials that slip through.