99402

Preventive Medicine Counseling and Risk Factor Reduction Intervention, Individual, Approximately 30 Minutes

CPT code 99402 is defined as preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual, spanning approximately 30 minutes of face-to-face time. This code is part of the Preventive Medicine Services section of the CPT manual and is specifically designed for encounters where the primary focus is health promotion and disease prevention rather than the management of an acute or chronic illness. The service is typically provided to patients who are asymptomatic or to those whose counseling needs are distinct and significant enough to warrant a separate service from a standard evaluation and management visit. During the 30-minute session, the healthcare provider must perform a targeted assessment of the patient's lifestyle and behavioral risks. This includes evaluating the patient’s diet, level of physical activity, use of tobacco or other substances, sexual practices, and potential for injury or environmental exposures. The clinician then provides tailored education and counseling aimed at reducing these specific risk factors. A key component of 99402 is the application of motivational interviewing techniques or other behavioral change models to assess the patient's readiness to change and to assist them in developing a concrete plan for risk reduction. Documentation for 99402 must be comprehensive, specifically detailing the risk factors addressed, the nature of the counseling provided, the patient's response or goals set, and clearly stating the total time spent in the encounter to justify the use of the 30-minute code. If the provider spends significantly less time, such as 15 minutes, code 99401 would be more appropriate. It is important to note that 99402 is often used in primary care settings but is frequently subject to specific payer policies regarding coverage, particularly since many payers, including Medicare, may require specific HCPCS G-codes for certain types of preventive counseling like obesity or smoking cessation instead of the 99402 code.

Clinical Indications

  • Obesity and weight management counseling
  • Tobacco use cessation counseling
  • High-risk sexual behavior prevention
  • Sedentary lifestyle and physical activity promotion
  • Alcohol or substance misuse screening and brief intervention
  • Dietary and nutritional counseling for disease prevention
  • Family history of chronic disease (e.g., heart disease, diabetes)
  • HIV and sexually transmitted infection (STI) prevention counseling
  • Injury prevention counseling (e.g., fall prevention in elderly)
  • General lifestyle modification for health maintenance

Procedure Steps

  1. Review the patient's medical and social history to identify potential health risk factors.
  2. Perform a face-to-face assessment of the patient's current lifestyle behaviors (e.g., diet, exercise, substance use).
  3. Determine the patient's stage of change or readiness to modify high-risk behaviors.
  4. Provide specific, evidence-based education regarding the health risks associated with current behaviors.
  5. Collaborate with the patient to set realistic, measurable goals for health improvement and risk reduction.
  6. Develop a personalized action plan or provide resources (e.g., referrals, educational materials) to support behavioral change.
  7. Document the total time spent in the counseling session, specific risk factors addressed, and the intervention provided.

Coding Guidelines

  • Report 99402 for individual counseling sessions lasting approximately 30 minutes.
  • This code is intended for patients without symptoms or established illness related to the counseling topic.
  • For counseling sessions lasting approximately 15 minutes, use code 99401.
  • If the counseling is performed on the same day as a separate and significant Evaluation and Management (E/M) service, append modifier 25 to the E/M code.
  • Do not report 99402 in conjunction with comprehensive preventive medicine codes (99381-99397) for the same encounter, as counseling is considered part of those codes.
  • Note that Medicare often bypasses these CPT codes in favor of specific HCPCS G-codes for preventive services (e.g., G0444 for depression screening, G0447 for obesity counseling).
  • The code is used for individual counseling; for group sessions, see codes 99411 and 99412.

Associated ICD-10 Codes