Just as you are the first line of defense for your patients, accurate CPT coding guarantees frontline protection against medical claim denials.
CPT coding for primary care services is not an easy feat. Primary care practitioners or providers render a variety of services to diagnose, treat, and manage a multitude of health issues. They realize the magnitude and complexity of this task only when they sit down to translate these services into 5-digit current procedural terminology (CPT) codes.
With hundreds of CPT codes covering primary care services like routine visits, diagnostic tests, wellness examinations, preventive care, vaccinations, therapeutic procedures, and special care, physicians can easily lose their way.
Luckily, we have covered this year’s most common primary care CPT codes. So, take a look.
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Most Used CPT Codes for Primary Care Visits
The most frequently reported primary care CPT codes for office visits with new and regular patients are as follows.
CPT Code 99202-99205 – Outpatient E/M Visit, New Patient
Primary care practitioners often provide evaluation and management (E/M) services in office or outpatient settings. During these timed visits, the practitioner oversees cases with varying degrees of complexity. CPT codes 99202-99205 are used for primary care visits with new or first-time patients. Details are as follows:
| CPT Code | Description | Duration |
|---|---|---|
| 99202 | In this E/M visit, the provider meets a new patient (face-to-face) and makes straightforward decisions. This visit is for less complicated cases and may include recording the patient’s medical and family history, conducting a detailed examination, etc. | 15 minutes or more |
| 99203 | This primary care CPT code is for E/M visits that require a low level of medical decision-making when meeting new patients. | 30 minutes or more |
| 99204 | This code is reported when a primary care provider meets a new patient in an office or outpatient setting and makes moderate levels of medical decisions. | 45 minutes or more |
| 99205 | This CPT code for primary care visits is used when the provider sees a new patient and makes high-level medical decisions, such as what kind of treatment method should be used for the high-risk case, etc. | 60 minutes or more |
CPT Code 99211-99215 – Outpatient E/M Visit, Established Patient
In contrast, 99211-99215 CPT codes for primary care visits cover timed meetings or consultations with established or returning patients in an office or outpatient setting.
Again, these E/M visits involve less complicated to most complicated medical decision-making, depending on the returning patient’s condition. You may refer to the table for details.
| CPT Code | Description | Duration |
|---|---|---|
| 99211 | This primary care CPT code is reported when an established patient visits a provider’s office, and a face-to-face encounter takes place with a clinical staff other than the primary physician, such as a nurse practitioner (NP), a physician assistant (PA), or any other nonphysician practitioner (NPP). The physician may or may not supervise this visit. | 5 minutes or more |
| 99212 | During this E/M visit, the provider directly meets an established patient and makes straightforward medical decisions. | 10 minutes or more |
| 99213 | This CPT code for primary care visits is used when a provider meets a returning patient face-to-face and makes low-level medical decisions, such as increasing or decreasing the dosage, etc. | 20 minutes or more |
| 99214 | In this E/M visit with an established patient, the provider makes a moderate level of medical decisions, such as changing the treatment plan, etc. | 30 minutes or more |
| 99215 | This last CPT code for primary care visits involves a high level of medical decision-making for an established patient. The provider meets the patient face-to-face in an office or outpatient setting. | 40 minutes or more |
Common Primary Care CPT Codes for Vaccinations
The most commonly used vaccination CPT codes for primary care are as follows.
CPT Codes 91318-91322 – COVID-19 Vaccine & Immunization
How can we start our primary care CPT codes guide for vaccinations without listing the COVID-19 vaccine on the top? The coronavirus disease that became prevalent in 2019 and triggered a global pandemic continues to wreak havoc in our lives. The first vaccinations were made available in December 2020, and the vaccination drive continues to date with recommended annual booster shots.
The following table lists this year’s primary care CPT codes for COVID-19 vaccination and their descriptions.
| CPT Code | Description | Product | Dosage |
|---|---|---|---|
| 91318 | The provider injects a SARS–CoV–2 vaccine product (tris–sucrose formulation) into the patient’s muscle. The patient must be between 6 months and 4 years old. | Pfizer | 3 mcg/0.2 mL |
| 91319 | The provider injects a SARS–CoV–2 vaccine product (tris–sucrose formulation) intramuscularly. The patient must be between 5 and 11 years old. | Pfizer | 10 mcg/0.2 mL |
| 91320 | The provider injects a SARS–CoV–2 vaccine product (tris–sucrose formulation) intramuscularly. The dosage must be administered to patients 12 years and older. | Pfizer | 30 mcg/0.3 mL |
| 91321 | The provider administers a SARS–CoV–2 mRNA-LNP vaccine product for intramuscular use in patients 6 months to 11 years old. | Moderna | 25 mcg/0.25 mL |
| 91322 | The provider administers a SARS–CoV–2 mRNA-LNP vaccine product into the patient’s muscle. The patient must be 12 years or older. | Moderna | 50 mcg/0.5 mL |
CPT Codes 90736 and 90750 – Shingles Vaccine
Primary care CPT codes 90736 and 90750 are reported when healthy adults aged 50 and above are vaccinated against shingles. Caused by the varicella-zoster virus, Shingles is a painful rash on the skin that develops when the chickenpox virus is reactivated in an adult who had it as a child. It is often accompanied by nerve pain. The disease, however, is not life-threatening.
90736 CPT code for primary care is reported when the healthcare provider administers a subcutaneous injection with a live vaccine to protect the patient against shingles infection. Similarly, code 90750 is used when the provider injects an adjuvanted vaccine into the muscle for prevention.
CPT Codes 90649 & 90651 – Human Papillomavirus (HPV) Vaccine
In the USA, adults between the ages of 18 and 26 are most likely to be vaccinated for HPV. The vaccination could be administered as early as 11 and 12 for girls and boys, respectively. According to the Centers for Disease Control and Prevention (CDC), human papillomavirus is the most common sexually transmitted infection in the USA, and it can lead to cervical, anal, or oral cancers.
Healthcare practitioners use the primary care CPT code 90649 to report that an altered form of human papillomavirus was injected into a muscle for immunity against 4 types of HPV. The vaccine is administered as part of a 3-dose schedule.
Likewise, primary care CPT code 90651 is used when the provider injects a nonvalent HPV intramuscularly for protection against nine strains of human papillomavirus. Again, the vaccine is administered in two or three doses.
CPT Codes 90678, 90679, & 90683 – Respiratory Syncytial Virus (RSV) Vaccine
This fall season, all adults aged 60 and above are recommended RSV shots for protection against respiratory infections. Primary care CPT codes 90679, 90678, and 90683 are used to report the vaccination.
Code 90678 is reported when the physician injects a bivalent prefusion F vaccine product into the muscle. In contrast, CPT code 90679 for primary care is used when the provider administers a prefusion F (preF) vaccine product along with an adjuvant into the muscle for a better immune response against RSV.
However, primary care CPT code 90683 represents injecting a vaccine product like Moderna’s mRESVIA (0.5 mL syringe) into the muscle to prevent RSV infection. The mRNA vaccine works through lipid nanoparticles.
CPT Codes 90702, 90714, & 90715 – Tetanus, Diphtheria, & Pertussis (Tdap) Vaccines
90702, 90714, and 90715 are all CPT codes for primary care and are used to report a combination of Tetanus, Diphtheria, and Pertussis (Tdap) vaccination to the highest level of specificity. CDC recommends Tdap vaccination for all Americans aged 7 and above, and individuals must get a booster every 10 years.
It is a 3-in-1 vaccination that offers combined protection against whooping cough (pertussis), breathing problems (diphtheria), and lockjaw (tetanus).
The primary care CPT code 90702 indicates that the provider administered a Tdap vaccine intramuscularly to a patient younger than 7 years. Similarly, code 90714 is reported when the provider injects a preservative-free Tdap vaccine into the muscle of a patient older than 7 years. CPT code 90715, however, represents a booster dose for Tdap in patients 7 years and older.
Frequently Used Primary Care CPT Codes for Preventive Care
Primary care practitioners offer several preventive services, including lifestyle counseling, routine check-ups and screenings, annual flu shots, interventional treatments, disease management, and more.
These preventive care services are delivered face-to-face in an office setting or via online communication technologies (telehealth). Moreover, the services are offered to new and established patients and specified through the correct primary care CPT codes.
CPT Codes 99381-99387 – Preventive Visits, New Patients
Primary care CPT codes 99381-99387 are used to report preventive care visits of new patients. Such visits are integral to primary care and include comprehensive wellness examinations, consultations, and counseling for overall health management.
This code range covers new patients as young as a few months (children under the age of one) and as old as 65+. In medical terms, these preventive visits are known as “well-patient visits”.
CPT Codes 99391-99397 – Preventive Visits, Established Patients
Primary care CPT codes 99391 to 99397 cover established patients’ well-patient visits and routine physical check-ups. Most often, such preventive visits occur annually and are not critical. Established or returning patients do not seek the provider’s immediate medical attention during these visits. Instead, the returning patient’s gender, age, and associated risk factors are considered for effective preventive care.
Besides recording the patient’s past family and social history (PFSH), the physician may also order lab tests to check for abnormalities. The CPT codes for primary care preventive visits with established patients are also age-specific and offered to children as young as 5 (code 99393) and adults as old as 65 and above (code 99397).
CPT Codes 99401-99429 – Preventive Medicine Counseling & Intervention
Under this CPT code range, healthcare providers offer individual and group counseling and interventions for behavior change to new and established patients at risk of developing diseases and conditions.
99401-99429 CPT codes for primary care also cover additional preventive medicine services, such as treatment or management of a health issue over a virtual call (telemedicine). CPT codes specifically used for telemedicine are time-based and indicate that the service lasts up to 7 days.
| CPT Code Range | Category | General Description |
|---|---|---|
| 99401 – 99404 | Preventive Medicine, Individual Counselling | This primary care CPT code range covers 15-60 minutes of one-on-one counseling on health management based on the patient’s age, family history, and physical condition. The physician analyzes areas of concern and suggests preventive measures for risk factor reduction. |
| 99406 – 99409 | Behavior Change Interventions, Individual | Primary care providers must refer to this CPT code range when they seek reimbursements for behavior change interventions with one patient lasting between 10 and 30 minutes. During such sessions, the provider counsels the patient on quitting tobacco or screens him for alcohol or other non-tobacco substance abuse while performing a brief intervention. |
| 99411 – 99412 | Preventive Medicine, Group Counseling | Primary care CPT codes 99411 and 99412 must be reported when billing time-based group counseling on subjects such as maintaining and improving physical health. |
| 99421 – 99429 | Other Preventive Medicine Services | This primary care CPT code range must be referred to when the provider bills timed telehealth sessions for treatment and health management OR when the provider (or other licensed healthcare professional) personally delivers management and care plan services to a patient with a complex chronic condition. |
Most Used Primary Care CPT Codes for Lab Tests
Primary care physicians often order laboratory tests to diagnose various health conditions. The lab or diagnostic tests also help the physician monitor and treat the conditions. Therefore, a primary care provider must be familiar with the CPT codes for most ordered lab tests, such as blood, thyroid, and lipid panel tests.
CPT Code 85025 – Complete Blood Count (CBC) Blood Test
Primary care CPT code 85025 falls under hematology and coagulation procedures. It denotes a comprehensive blood test called the complete blood count (CBC).
The primary care provider orders it to know the number of red blood cells, white blood cells, and platelets in a patient’s blood and the hemoglobin level. Some other details like hematocrit, mean corpuscular volume (MCV), and mean corpuscular hemoglobin concentration (MCHC) are also mentioned in the CBC report. The complete count of 7 types of cells in the human blood helps diagnose conditions like infections, anemia, and leukemia.
85025 CPT code for primary care is reported when a pathologist or lab technician draws blood from a patient’s vein using a syringe and stores it in a labeled test tube containing an anticoagulant (usually EDTA or citrate) for seamless transportation to the blood testing laboratory. In the lab, an automated analyzer counts the number of different types of blood cells, and a test report is printed for the ordering physician’s perusal.
CPT Code 80048 – Basic Metabolic Panel (BMP) Test
80048 is another commonly used CPT code for primary care lab tests. It is a go-to lab test in primary care practice, and physicians order it when they want to assess a patient’s general physical health, such as kidney function, electrolyte level in the body, and fluid balance.
Reporting primary care CPT code 80048 means that the lab technician conducts a blood test to measure the blood levels of eight substances in the patient’s body – calcium, potassium, sodium, glucose, carbon dioxide, creatinine, chloride, and blood urea nitrogen (BUN).
CPT Code 80061 – Bundled Lipid Panel Test
A primary care physician may order a comprehensive lipid panel test when he suspects that the patient is at risk of coronary heart disease or stroke.
Hence, the 80061 is a bundled CPT code for primary care lab tests and includes measuring the levels of three fats in the blood – total cholesterol (code 82465), triglycerides (code 84478), and HDL cholesterol (code 83718).
It should be noted that the lipid panel test is a blood test performed by a qualified pathologist or lab technician.
CPT Code 84436 – Thyroid Function Test
A thyroid function test is performed to check if the patient suffers from a thyroid disorder or an underactive thyroid gland. Thyroid diseases lead to inconvenient symptoms like moodiness, lethargy, weight gain, and anxiety. Moreover, patients with thyroid disorders are at a greater risk of heart disease. Therefore, primary care physicians recommend a thyroid function test when they notice such symptoms.
The primary care CPT code 84436 is specifically used when a lab technician performs a blood test to measure the amount of thyroxine (T4) in the blood. T4 is a hormone that the thyroid gland produces to manage a person’s growth and development. Like all other blood tests mentioned before, the pathologist draws blood from the patient’s vein and sends the specimen to the lab for testing.
Common Primary Care CPT Codes for Special Care
Primary care physicians also address the special healthcare needs of their patients. They offer a range of special care services, such as diagnostic imaging, screenings, and therapeutic procedures to treat patients of all genders and ages.
From infants to pregnant women and teenagers to senior citizens, everyone is eligible for special care at primary care practices. Following are some commonly used primary care CPT codes for special care.
CPT Code 93303 – Complete Transthoracic Echocardiography
Out of every one thousand infants born in the USA, eight have a heart defect or congenital heart disease (CHD). Due to the abnormality in the heart structure, people with CHD experience symptoms like shortness of breath, palpitations, fatigue, and cyanosis.
When a primary care provider detects these symptoms, he may order complete transthoracic echocardiography to observe the structure of the heart. Hence, the primary care CPT code 93303 is reported when an echocardiography machine is used to obtain images of the heart structures, including its chambers, walls, and valves, and to visualize cardiac activity and blood flow. Moreover, code 93303 specifies that the procedure has a technical and professional component.
CPT Code 99177 – Bilateral Eye Screening
Another commonly reported CPT code for primary care is 99177. Vision tests or screenings are a special component of primary healthcare. Therefore, primary care physicians frequently use CPT code 99177 to inform the insurance payers that a bilateral eye screening exam was performed.
The physician uses instruments to examine both eyes of the patient and check for ocular (eye-related) diseases. Again, the service includes technical and professional components because the screening and analysis take place on-site and during the same session.
CPT Code 94640 – Nebulizer Treatment
Primary care CPT code 94640 is reported when physicians treat obstruction of the air passages using nebulizers.
For instance, when patients suffering from asthma attacks or chronic lung diseases experience difficulty breathing, the physician administers pressurized or nonpressurized inhalation treatment to open the blocked airways. The procedure may also be used for sputum induction for lab analysis.
Bottom Line
Ask healthcare providers from any medical specialty, and they will tell you that coding is the most challenging aspect of medical billing. CPT codes for primary care services cover several diagnoses, visits, treatments, and procedures. Hence, just using them to the highest level of specificity can be perplexing.
Even when you are aware of the most common ones (for this year), primary care CPT codes, too, are revised annually. It can be a herculean task to keep up with the updates and refrain from using outdated ones. If your coding struggles seem insurmountable, we can help. Our primary care billing services include accurate CPT coding executed by AAPC-certified coders.
