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Complete Guide to Primary Care CPT Codes (2025)

A professional women give primary care service doctor use the primary care cpt codes

What Are Primary Care CPT Codes?

Primary Care Current Procedural Terminology (CPT) codes are used by healthcare providers to bill for medical services, ensuring accurate documentation and reimbursement. These codes categorize evaluation, management, preventive care, chronic care management, and digital health services.

Common Primary Care CPT Codes

Evaluation and Management (E/M) Codes (99201–99499)

  • Used for office visits and outpatient services.
  • Lower-level codes represent less complex visits, while higher-level codes indicate more complex evaluations.

Preventive Care for New Patients (99381–99387)

  • Covers wellness exams, consultations, and counseling.
  • Age-specific services for children (starting at age 5) and adults up to 65+.

Preventive Care for Established Patients (99391–99397)

  • Includes routine physical check-ups and health screenings.

Digital and Remote Health CPT Codes

Online Digital Evaluation and Management (E/M) Services

  • 99421: Patient communication and evaluation (5-10 minutes over 7 days).
  • 99422: Extended consultation (11-20 minutes over 7 days).
  • 99423: Comprehensive digital evaluation (21+ minutes over 7 days).

Remote Physiologic Monitoring (RPM) and Treatment Management

  • 99473: Self-measured blood pressure education and device calibration.
  • 99474: Data collection from self-measured blood pressure over 30 days.
  • 99457: RPM management, requiring interactive communication (20 minutes per month).
  • 99458: Additional RPM management (extra 20 minutes).

Chronic Care Management (CCM) CPT Codes

  • 99490: Monthly care for chronic conditions (20+ minutes of clinical staff time).
  • G2058: Additional CCM (extra 20 minutes per month).
  • 99487: Complex CCM (60 minutes per month for two or more chronic conditions).
  • 99489: Additional complex CCM (extra 30 minutes per month).
  • G2064: Principal Care Management for a single high-risk disease (30 minutes per month).
  • G2065: Staff-directed Principal Care Management (30 minutes per month).

Behavioral Health and Psychiatric CPT Codes

Psychiatric Collaborative Care Model

  • 99492: Initial psychiatric care management (70 minutes in the first month).
  • 99493: Ongoing psychiatric care management (60 minutes per subsequent month).
  • 99494: Additional psychiatric care management (extra 30 minutes per month).

Behavioral Health Management

Advance Care Planning CPT Codes

  • 99497: Discussion and completion of advance directives (30 minutes, face-to-face).
  • 99498: Additional time for advance care planning (extra 30 minutes).

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Resources for CPT Code Look-Up

Centers for Medicare & Medicaid Services (CMS): This site offers a free CPT code search tool.

American Medical Association (AMA): Provides CPT/RVU Data File licenses for integration into medical billing systems.

FAQs:

  • What are the most common primary care CPT codes?

    The most common CPT codes for primary care include 99201–99499 for office visits, 99381–99397 for preventive care, and 99490–99498 for chronic care and advance care planning.

  • How do I find the right CPT code for a primary care visit?

    You can look up CPT codes through CMS or AMA resources or consult with a medical billing professional.

  • What CPT codes are used for telehealth and remote monitoring?

    Online digital evaluation codes (99421–99423) and remote physiologic monitoring codes (99457–99458) are commonly used for telehealth services.

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