Preventive & wellness codes

Annual physicals and well-visits are billed with age-based preventive codes, and under most insurance they're supposed to be fully covered with no out-of-pocket cost. The most common — and most checkable — error in this whole category is a “free” preventive visit that gets billed as, or alongside, a problem-focused office visit (often with a modifier), quietly turning a no-cost checkup into a surprise bill. The codes below explain which preventive code matches which age band and exactly what to look for if a wellness visit came back with a charge.

• 99391 Routine well-baby preventive visit, infant under age 1 (established patient)
• 99395 Routine annual wellness visit, adult age 18-39 (established patient)
• 99396 Routine annual wellness visit, adult age 40-64 (established patient)