CPT Code For Physical Exam 2023

The CPT codes and billing guidelines for physical exams can be found below.

How To Bill CPT Code For Physical Exam (DOT Code)

DOT (Department Of Transportation) physicals may not be billed to insurance companies. They are either billed to the employer, or the Provider may collect money from the person.

Therefore, these services can be priced at the Provider’s discretion, and using a CPT code is unnecessary. The diagnosis code would be either V70.3 (Other general medical examination for administrative purposes) or V70.5 (Health examination of defined subpopulation)

List Of CPT Codes For Physical Exam

There are Physical exam CPT codes for new patients and for established patients.

Physical Exam CPT Codes For New Patients

CPT 99381: New patient annual preventive exam (younger than one year).

CPT 99382: New patient annual preventive exam (1-4 years).

CPT 99383: New patient annual preventive exam (5-11 years).

CPT 99384: New patient annual preventive exam (12-17 years).

CPT 99385: New patient annual preventive exam (18-39 years).

CPT 99386: New patient annual preventive exam (40-64 years).

CPT 99387: New patient annual preventive exam (65 years and older).

Physical Exam CPT Codes For Established Patients

CPT 99391: Established patient annual preventive exam (younger than one year).

CPT 99392: Established patient annual preventive exam (1-4 years).

CPT 99393: Established patient annual preventive exam (5-11 years).

CPT 99394: Established patient annual preventive exam (12-17 years).

CPT 99395 Established patient annual preventive exam (18-39 years).

CPT 99396: Established patient annual preventive exam (40-64 years).

CPT 99397: Established patient annual preventive exam (65 years and older).

Diagnosis Codes For Physical Exam

CPT Z00.00: Encounter for general adult medical examination without abnormal findings.

CPT Z00.01: Encounter for general adult medical examination with abnormal findings.

CPT Z00.110 – CPT Z00.129: Newborn, infant, and child health examinations appropriate for patient age.

CPT Z30.011 – CPT Z30.9: Encounter for contraception management, as appropriate.

Modifier For Physical Exam

If a new abnormal finding occurs during a preventive exam, or a significant preexisting problem requires extra work (and the critical components of a problem-oriented Evaluation and Management service are met; code CPT 99202 – CPT 99215 and report modifier 25.