The 99394 CPT code is for a periodic comprehensive preventive medicine reevaluation and management service for an established patient, ages 12-17 years. For well visits in adolescents, which include age and gender appropriate history, exam, counseling, anticipatory guidance, risk factor reduction and ordering of laboratory or diagnostic tests as needed.
The service is included in the service code family for established patient preventive medicine. Correct coding is largely dependent on the age of the patient and established patient status, as well as documentation for the patient that the preventive service was actually administered.
Other age-appropriate services that may occur during adolescent preventive visits include screening, immunizations, behavioral health assessment, substance use risk assessment, and reproductive health discussion. If the CPT and payer requirements are met, some of the above services may be reportable separately.
Quick Answer
99394 CPT Code is for a periodic comprehensive preventive medicine reevaluation and management service, for an established patient, for ages 12-17 years. This is an adolescent preventive/well visit code. It is not selected on the basis of MDM or a given time limit (such as 20 minutes or 30 minutes or other). The visit will consist of an age-appropriate history and examination, counselling, anticipatory guidance, risk factor reduction interventions and where appropriate ordering of laboratory or diagnostic investigations.
99394 CPT Code at a Glance
| Coding Element | 99394 Details |
|---|---|
| CPT code | 99394 |
| Service category | Preventive medicine E/M |
| Patient status | Established |
| Patient age | 12 through 17 years |
| Visit type | Periodic comprehensive preventive reevaluation |
| Common description | Adolescent well-child or preventive visit |
| MDM-based selection | No |
| Time-based selection | No |
| History | Age and gender appropriate |
| Examination | Age and gender appropriate |
| Counseling | Included |
| Anticipatory guidance | Included |
| Risk-factor reduction | Included |
| Diagnostic/laboratory orders | Included when appropriate |
| Common comparison | 99384 for new patients |
| Additional problem E/M | May be reported when separately identifiable |
| Modifier 25 | May apply to qualifying additional E/M |
| Modifier 33 | Not required for inherently preventive E/M |
| 2026 work RVU | 1.70 |
| 2026 non-facility PE RVU | 1.76 |
| 2026 facility PE RVU | 0.37 |
| 2026 malpractice RVU | 0.11 |
| 2026 total non-facility RVU | 3.57 |
| 2026 total facility RVU | 2.18 |
What Is the 99394 CPT Code?
99394 CPT Code description is a periodic comprehensive preventive medicine reevaluation and management service, provided to an established adolescent patient. Preventive medicine codes are based on a comprehensive approach to health supervision, rather than problem-oriented office visit codes. The service is not mainly about identifying or curing a particular disease but rather about the prevention of diseases.
The CPT description includes:
- Age and gender appropriate history
- Age and gender appropriate examination
- Counseling
- Anticipatory guidance
- Risk-factor reduction interventions
- Ordering of laboratory procedures
- Ordering of diagnostic procedures
The patient’s age and established status determine whether 99394 is the applicable preventive medicine code.
Who Qualifies for 99394 CPT Code?
A patient must meet two primary criteria for 99394 CPT Code:
- The patient is 12 through 17 years old on the date of service.
- The patient is an established patient under CPT rules.
Established patient status generally means the patient has received professional services from the physician or another physician or QHP of the same specialty and same group within the previous three years. Status of the patient and age should be verified separately. A 15-year-old who has no prior familiarity with the practice does not automatically qualify for 99394, just because the age is right. The codes for preventive medicine for an adolescent patient are mostly 99384.
What Age Does 99394 CPT Code Cover?
CPT code 99394 applies to established patients 12 through 17 years of age.
The preventive medicine code family is divided by patient age:
| Patient Status | Age | CPT Code |
|---|---|---|
| New patient | 12 through 17 | 99384 |
| Established patient | 12 through 17 | 99394 |
For established pediatric patients, the age ranges progress as follows:
| Age | Established Preventive Code |
|---|---|
| Under 1 year | 99391 |
| 1 through 4 years | 99392 |
| 5 through 11 years | 99393 |
| 12 through 17 years | 99394 |
| 18 through 39 years | 99395 |
The age category is based on the patient’s age at the time of service.
What Does a 99394 CPT Code Preventive Visit Include?
A 99394 CPT Code encounter is a broad one that encompasses more than one complaint. The service may include aspects of physical health, emotional health, development, behavior, safety, nutrition, school issues, social issues and other prevention-related needs as they pertain to the adolescent age group.
Common components include:
- Comprehensive preventive history
- Physical examination
- Growth assessment
- Blood pressure measurement
- BMI assessment
- Immunization review
- Vision and hearing assessment when indicated
- Mental health screening
- Substance-use risk assessment
- Reproductive health counseling
- Nutrition counseling
- Physical activity counseling
- Injury prevention counseling
- Risk assessment
- Age-appropriate laboratory or diagnostic testing
The exact services provided need to match the patient’s clinical situation, age, recommended preventive-care services, and requirements of the payers.
99394 CPT Code and Bright Futures Recommendations
The Bright Futures/American Academy of Pediatrics Periodicity Schedule is an age-based approach to preventive pediatric health care from infancy to adolescence. Bright Futures focuses on anticipatory guidance, immunizations, screening, the physical exam, and preventing problems in the history of the adolescent visit. The schedule is for age-appropriate preventive care and may call for extra visits if health issues are discovered, the AAP says.
The Bright Futures framework can help practices organize the clinical content of adolescent preventive visits. It does not replace CPT coding rules or individual payer requirements. The AAP’s 2026 Coding for Pediatrics manual specifically addresses preventive medicine services and combinations of preventive services, making it a relevant coding reference for pediatric practices.
Adolescent Screening With 99394 CPT Code
Screening plays an important role in adolescents’ preventive care.
The preventive visit may involve screening and risk assessment in the following areas as appropriate:
- Depression
- Behavioral and emotional concerns
- Substance use
- HIV
- Dyslipidemia
- Anemia
- Tuberculosis risk
- Vision
- Hearing
- Oral health
- Nutrition and physical activity
AAP preventive-care quality measures also highlight areas for screening for adolescents, such as vision screening, hearing screening, tuberculosis, anemia, dyslipidemia, alcohol and substance use, BMI, depression, HIV, and cholesterol screening. Not all screening services are offered at each 99394 visit. The type of screening that is warranted will be dependent on age, risk factors, clinical judgment, current recommendations, and payer requirements.
Depression Screening During 99394 CPT Code
Mental health screening is particularly relevant during adolescent preventive care. The AAP Bright Futures framework includes adolescent depression screening among preventive services. The screening result should be documented along with appropriate follow-up when a concern is identified.
When a standardized screening instrument is used, the documentation should identify the tool or service performed and record the relevant result according to the requirements of the separately reportable service. Positive screening could result in further evaluation or treatment. When all requirements are met, the additional E/M may be reportable if the provider provides a significant, separately identifiable problem oriented E/M service other than the preventive work.
Substance Use and Risk Assessment
Alcohol, smoking, drug abuse and other behavioral issues are the main concerns in adolescent preventive care. Anticipatory guidance/counseling may be included in the preventive visit for certain areas of concern like substance abuse, injuries, nutrition and physical activity.
Documentation should reflect the preventive counseling or risk assessment conducted. Do not record general counseling words that don’t represent the patient’s interaction. When a specific problem requires additional evaluation or treatment beyond the preventive service, the provider should document that work separately.
Immunizations With 99394 CPT Code
Immunizations are commonly provided during adolescent preventive visits. When vaccines are administered, the vaccine product and administration services are reported using the applicable CPT codes. The preventive E/M service remains separately identifiable because the preventive visit and vaccine administration represent different services.
The claim should include the appropriate vaccine product code and administration code when applicable. Documentation should support the vaccine administered, administration details, and required counseling when a counseling-based administration code is used. AAP coding guidance addresses the reporting of preventive services with immunizations and other services.
2026 Immunization Counseling Changes
CPT changes for 2026 introduced new stand-alone immunization counseling codes for situations in which recommended vaccines are discussed but not administered. The AAP’s 2026 CPT update notes new immunization counseling codes in the 90482 through 90484 range. These codes have specific reporting requirements and should not be substituted for vaccine administration codes when a vaccine is actually administered. Practices should verify the current CPT descriptor and payer policy before reporting these counseling codes with a preventive visit.
Can 99394 CPT Code Be Billed With Another E/M?
Yes, a preventive medicine service can be reported with a separate problem-oriented E/M service when the patient receives significant, separately identifiable evaluation and management on the same date. The additional E/M service must represent work beyond the preventive service.
For example, an adolescent may present for a routine preventive examination and also have a new medical problem requiring separate evaluation, assessment, and treatment. The documentation should clearly support both services.
Modifier 25 With 99394 CPT Code
The Modifier 25 can be applied to the additional problem-oriented E/M service if the criteria are fulfilled.
For example:
99394 + 99213-25
In this instance, 99394 is the preventive service and 99213-25 is a significantly separately identified problem-oriented E/M service. Modifier 25 should not be added simply because the patient has a diagnosis in addition to the preventive examination. The additional problem must require separate evaluation and management beyond the work included in 99394.
Modifier 33 and 99394 CPT Code
Modifier 33 is not needed when the E/M service is “inevitably preventive” (99394). According to the AAP 2026 CPT, the application of modifier 33 in cases of services that are “intrinsically” preventive like the preventive E/M codes (99391-99397) has been explained. The use of modifier 33 in all 99394 claims should not be routinely done. This means practices should not automatically append modifier 33 to every 99394 claim. Modifier use should instead follow the actual service, CPT instructions, and payer requirements.
Does 99394 CPT Code Have a Time Requirement?
99394 is not selected using a specific time threshold. The preventive medicine code family is not a level chosen based on total encounter time, like the office E/M codes (99212 or 99213).f The service is defined by its preventive nature, patient age, patient status, and required comprehensive preventive components. A provider may spend different amounts of time with different adolescent patients. Time alone does not convert a 99394 service into a higher preventive medicine code.
Does MDM Determine 99394 CPT Code?
No. Medical decision making does not determine whether an established adolescent preventive visit is 99394. MDM is used to select the level of problem-oriented office E/M services. Preventive medicine codes are reported based on the preventive service provided and the applicable patient category. If a separate problem-oriented E/M service is performed during the same encounter, MDM or time may determine the appropriate additional E/M code.
99394 CPT Code Documentation Requirements
Documentation should demonstrate that a comprehensive adolescent preventive service was performed.
A useful 99394 record may include:
| Documentation Area | Examples |
|---|---|
| Patient status | Established patient |
| Age | 12 through 17 years |
| Preventive history | Medical, developmental, behavioral, social history |
| Examination | Age and gender appropriate examination |
| Growth | Height, weight, BMI and relevant growth assessment |
| Screening | Age-appropriate screening and risk assessment |
| Counseling | Nutrition, activity, safety, behavioral and health guidance |
| Immunizations | Vaccines reviewed or administered |
| Testing | Laboratory or diagnostic orders when indicated |
| Assessment | Preventive assessment and identified concerns |
| Follow-up | Recommendations, referrals, or follow-up plan |
Documentation should be based on what happened during the encounter. Avoid relying on a generic well-visit template when important adolescent screening or counseling was not performed.
Common 99394 CPT Code Documentation Problems
Several documentation issues can weaken a preventive claim.
Missing Age-Specific Assessment
The record should support the preventive nature of the adolescent visit rather than simply documenting a routine physical examination.
Generic Counseling Language
Counseling should reflect the subjects actually discussed with the patient or family.
Missing Screening Results
When screening is performed, the relevant result should be documented according to the requirements of that screening service.
Unsupported Additional E/M
A separate problem-oriented E/M requires documentation of significant, separately identifiable work.
Incomplete Immunization Documentation
Vaccine administration claims require appropriate documentation of the vaccine and administration service.
Copied Documentation
Copied text that does not reflect the current encounter can create inconsistencies between the patient’s actual care and the submitted claim.
99394 Diagnosis Coding
Diagnosis coding should reflect the reason for the preventive encounter and any additional conditions addressed. For a routine adolescent health examination without abnormal findings, Z00.129 may be appropriate when supported by the documentation. If the examination identifies an abnormal finding, the appropriate additional diagnosis should be reported when supported.
Other diagnosis codes may apply to services performed during the encounter. For example, Z23 may be reported for an encounter involving immunization when supported by the applicable coding guidelines. The diagnosis selection should reflect the actual services and findings rather than being chosen solely because a code is commonly associated with 99394.
99394 CPT Code RVU: 2026 Values
The following RVUs are provided for 99394 in the 2026 CMS July Physician Fee Schedule release:
| 2026 RVU Component | 99394 |
|---|---|
| Work RVU | 1.70 |
| Non-facility PE RVU | 1.76 |
| Facility PE RVU | 0.37 |
| Malpractice RVU | 0.11 |
| Total non-facility RVU | 3.57 |
| Total facility RVU | 2.18 |
The RVU26C file is the 2026 July CMS release. CMS refers to it as the release of the Physician Fee Schedule for July, 2026. The component values above are also reflected in current 2026 coding references using the CMS RVU26C data. RVUs are not a fixed reimbursement amount. Medicare payment calculations apply the relevant geographic practice cost indices and conversion factor to the applicable RVU components.
99394 CPT Code Reimbursement
There is no single nationwide reimbursement rate for 99394.
Payment can vary according to:
- Medicare payment rules when applicable
- Medicaid program rules
- Commercial payer contracts
- Geographic location
- Network status
- Place of service
- Payer fee schedule
- Patient benefits
- Coverage limitations
- Contractual adjustments
The CMS Physician Fee Schedule can be used to review Medicare payment information and RVUs for applicable services. CMS notes that payment rates are adjusted by locality using geographic practice cost indices. Commercial payer reimbursement should be verified against the provider’s contracted fee schedule rather than estimated from the CMS RVU alone.
99394 and Medicaid EPSDT
The Medicaid program’s EPSDT benefit has a unique emphasis on adolescent preventive care. EPSDT is obligated to give comprehensive preventive health services to all the children and youth under the age of 21 years who have the coverage of Medicaid. The benefit offers regular screening, medical and mental health services, developmental evaluation, vision and hearing screening, diagnostic follow-up and treatment when needed.
States administer Medicaid programs under federal requirements, but specific billing procedures, managed-care rules, screening schedules, and reimbursement policies can differ. CMS published an EPSDT coverage strategy guide in May 2026 and additional 2026 guidance addressing children’s behavioral health and EPSDT requirements. For practices serving Medicaid adolescents, checking the applicable state Medicaid or managed-care policy is therefore important before assuming that a national billing rule applies identically.
99394 vs 99384
The primary distinction between 99394 and 99384 is patient status.
| Feature | 99384 | 99394 |
|---|---|---|
| Patient status | New | Established |
| Age | 12 through 17 | 12 through 17 |
| Service | Initial preventive medicine | Periodic preventive medicine |
| Visit type | New adolescent preventive visit | Established adolescent preventive visit |
A patient can be within the correct adolescent age range but still require 99384 if the patient meets the CPT definition of a new patient.
99394 vs 99393
The difference between these codes is primarily the patient’s age.
| Code | Patient Status | Age |
|---|---|---|
| 99393 | Established | 5 through 11 |
| 99394 | Established | 12 through 17 |
The age range for 99394 is 12-17 years old. An 18-year-old could be in the 99395 age category, and a 10-year-old could be in the 99393 category.
99394 vs 99395
Both codes are established patient preventive medicine services, but their age ranges differ.
| Code | Patient Status | Age |
|---|---|---|
| 99394 | Established | 12 through 17 |
| 99395 | Established | 18 through 39 |
An adolescent who turns 18 is no longer reported with 99394 solely because the patient has an established relationship with the practice.
99394 vs 99213
99394 and 99213 represent different types of services.
| Feature | 99394 | 99213 |
|---|---|---|
| Service type | Preventive | Problem-oriented E/M |
| Patient | Established | Established |
| Age restriction | 12 through 17 | No specific age restriction |
| MDM selection | No | Yes |
| Time selection | No | Yes |
| Primary purpose | Preventive health assessment | Evaluation and management of problems |
| Same-day reporting | May be combined with separate E/M | May be reported when separately identifiable |
A routine adolescent well visit should not be converted to 99213 simply because a condition is discussed. Conversely, a significant separately identifiable problem may support an additional 99213 when the documentation meets the requirements.
Can 99394 CPT Code Be Billed With a Problem Visit?
Yes, when the additional problem-oriented service is significant and separately identifiable. Consider an adolescent scheduled for a preventive visit who also reports persistent headaches. If the provider performs additional evaluation, assessment, treatment planning, or management that goes beyond the preventive service, an additional E/M may be appropriate. The documentation should separate the preventive work from the problem-oriented work.
For example:
99394 + 99213-25
The exact additional E/M level depends on the documented MDM or qualifying time.
99394 CPT Code With Laboratory Testing
Laboratory testing may be ordered as part of a preventive visit when clinically appropriate. The preventive E/M code does not automatically include every laboratory test performed by the practice or an outside laboratory.
When a laboratory service is separately reportable, the applicable laboratory CPT code and diagnosis support should be reviewed. Coverage can vary according to the patient’s insurance plan, preventive benefits, age, risk factors, and applicable screening recommendations.
99394 CPT Code and Vision or Hearing Screening
Vision and hearing screening may form part of adolescent preventive care when recommended or clinically appropriate. A separately reportable screening service should meet its own CPT requirements and documentation standards. The practice should not automatically bill every screening service performed during a well visit. Verify whether the service is separately reportable and whether the payer applies specific bundling or coverage rules.
Common 99394 CPT Code Billing Errors
Billing 99394 for a New Patient
99394 is an established patient preventive code. A new adolescent patient generally requires 99384 instead.
Using the Wrong Age Category
The age range for 99394 is 12-17 years old. An 18-year-old could be in the 99395 age category, and a 10-year-old could be in the 99393 category.
Selecting 99394 Based on Time
99394 is not selected using a time threshold. Time does not determine the preventive medicine code.
Selecting 99394 Based on MDM
MDM does not determine the preventive medicine code. It may determine a separate problem-oriented E/M when that service is reported.
Automatically Adding Modifier 25
Modifier 25 belongs on the additional problem-oriented E/M when its requirements are met. It should not be added automatically to every preventive claim.
Automatically Adding Modifier 33
AAP’s 2026 CPT guidance states that modifier 33 is not required for inherently preventive E/M services such as 99394.
Reporting Unsupported Screening Services
A screening service should have documentation supporting the service and meet applicable CPT and payer requirements.
Ignoring Medicaid Requirements
Medicaid EPSDT rules are important for pediatric and adolescent preventive services. State Medicaid and managed-care policies should be reviewed when applicable.
How to Reduce 99394 Denials
A focused pre-submission review can prevent many avoidable claim problems.
Verify Patient Status
Confirm that the adolescent meets the established patient definition.
Verify Age
Confirm that the patient is 12 through 17 on the date of service.
Review Preventive Documentation
Make sure the record supports the comprehensive preventive service.
Check Additional E/M Services
If another E/M code is reported, confirm that the problem-oriented service is significant and separately identifiable.
Review Modifier 25
Apply modifier 25 to the additional E/M when supported rather than automatically attaching it to the preventive code.
Verify Screening Documentation
Review documentation for screening services and separately reportable procedures.
Check Immunization Coding
Verify the vaccine product, administration service, counseling requirements, and payer rules.
Review Medicaid Policies
For Medicaid patients, confirm the applicable state or managed-care preventive service requirements.
Confirm Diagnosis Coding
Make sure diagnosis codes reflect the preventive encounter and/or any other condition evaluated.
99394 CPT Code Examples
Example 1: Routine Adolescent Well Visit
A 15-year-old FUP comes into the office for a routine checkup. The provider conducts an age-appropriate history and examination, conducts appropriate screening, discusses immunizations, discusses nutrition and physical activity and provides anticipatory guidance.
Report: 99394
Report: 99394
Example 2: New 15-Year-Old Patient
A 15-year-old comes to a practice for the first time and is a new patient.
The age range is correct, 99394 is not appropriate, the patient is new.
Consider: 99384
Example 3: Preventive Visit With Immunization
A 14 year old established patient gets a comprehensive adolescent preventive exam and is given recommended immunizations at one visit. The preventive E/M and applicable vaccine product and administration services can be reported if documentation and payer requirements are met.
Example 4: Preventive Visit With Separate Problem
A 16 year old comes for a well-child check-up and complains about headaches. The provider conducts extra assessment and treatment for the headaches other than the preventive service.
Potential reporting: 99394 + 99213-25
Documentation needs to be pertinent to both services and level of additional E/M.
Example 5: Preventive Visit With Screening
A 13-year old established patient has a preventive examination and age-appropriate behavioral health screening. The preventive visit is reported with 99394. A separately reportable screening service may also be coded when its specific requirements are satisfied.
99394 Billing Workflow
Use this workflow before submitting an adolescent preventive care claim to reduce coding errors and support accurate reimbursement.
Step 1: Verify patient age
Confirm the patient is 12 through 17 years old on the date of service. Age verification ensures the selected preventive medicine code matches the patient’s age range.
Step 2: Confirm established patient status
Verify that the patient meets the CPT definition of an established patient. Review the patient’s history when needed to confirm the appropriate preventive service category.
Step 3: Confirm the preventive service
Review the documentation for the comprehensive preventive history, examination, counseling, anticipatory guidance, and risk assessment performed. Make sure the documented services support the preventive visit reported on the claim.
Step 4: Review screening services
Identify screening services performed during the visit and verify their separate coding and documentation requirements. Check whether each screening service requires an additional code, modifier, or supporting diagnosis.
Step 5: Review immunizations
Confirm vaccine products, administration codes, and applicable counseling requirements are reported correctly. Verify that each vaccine and administration service is supported by the clinical documentation.
Step 6: Identify additional problems addressed
Determine whether the provider separately evaluated or managed an illness, injury, symptom, or chronic condition. Review the documentation to distinguish additional problem management from routine preventive care.
Step 7: Evaluate additional E/M services
If a problem-oriented E/M service was performed, confirm that it was significant and separately identifiable from the preventive service. The documentation should clearly support the additional evaluation and management work.
Step 8: Apply modifier 25 when appropriate
Append modifier 25 to the qualifying additional E/M service when the documentation supports a significant, separately identifiable service. Do not apply the modifier solely because another problem was mentioned during the preventive visit.
Step 9: Verify diagnosis coding
Ensure diagnosis codes accurately support the preventive service and any additional conditions addressed during the encounter. Confirm that reported diagnoses are consistent with the services documented in the medical record.
Step 10: Check payer-specific requirements
Review applicable commercial insurance, Medicaid, or managed-care requirements before submitting the claim. Payer policies may affect preventive coverage, additional services, modifiers, and required documentation.
99394 Coding Audit Checklist
Before submitting a 99394 claim, verify:
- Patient is 12 through 17 years old
- Patient meets established patient requirements
- Preventive service was medically appropriate
- Age-appropriate history is documented
- Appropriate examination is documented
- Counseling and anticipatory guidance are documented
- Risk assessment is documented when performed
- Screening services are supported
- Immunization services are correctly reported
- Additional E/M work is separately identifiable
- Modifier 25 is supported when used
- Modifier 33 is not added unnecessarily
- Diagnosis codes support the encounter
- Medicaid requirements are checked when applicable
- Payer-specific requirements are satisfied
Key Takeaways
The 99394 CPT code is for a periodic comprehensive preventive medicine reevaluation for a patient over 12 years of age and established as a patient. Services include age and gender appropriate history and exam, counseling, anticipatory guidance, risk factor reduction, and/or appropriate laboratory or diagnostic orders.
99394 is not picked based on MDM or any time limit. The preventive medicine code is determined by the patient’s age, status, and the nature of the encounter in question. Other preventative services such as mental health screening, drug and alcohol use assessment, immunizations and reproductive health counseling may also end up being included in the adolescent visit. Each separately reportable service will have its own CPT and payer requirements.
If a significant, separately identifiable problem-oriented E/M service is provided during the same encounter, then an additional E/M code can be reported with modifier 25 if the requirements are met. The appropriate use of modifiers, accurate diagnosis coding, accurate patient status review, appropriate preventive documentation, screening documentation, accurate age verification, and payer-specific requirements are all crucial to 99394 billing accuracy.
