CPT 99397: Preventive Visit, Established Patient, Age 65+
Periodic comprehensive preventive medicine reevaluation and management of an established patient, age 65 years and older.
Why CPT 99397 Claims Get Denied
Claims billed under CPT 99397 are frequently denied or downcoded for the following reasons. Understanding these patterns helps your practice reduce denial rates and recover revenue faster.
Medicare does not cover 99397 — requires AWV codes
Frequency limit exceeded
Incorrect code used for Medicare beneficiary
Documentation not supporting comprehensive exam
Billing Tips for CPT 99397
For Medicare patients, use G0438 (initial AWV) or G0439 (subsequent AWV) — Medicare does not pay 99397. Commercial plans for patients 65+ may accept 99397. Always verify which code the payer requires.
Documentation Requirements
To support a clean claim for CPT 99397, your clinical documentation should include:
Comprehensive updated history
Complete physical examination
Functional assessment
Fall risk evaluation
Cognitive screening
Medication review and reconciliation
Advance care planning discussion
Common Modifiers for CPT 99397
Reduce CPT 99397 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.