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This guide covers the official AMA descriptor language for CPT code 99396, patient eligibility rules, the documentation required to pass audit, ICD-10 diagnosis code selection, payer-specific reimbursement and frequency policies, modifier applications including Modifier 25 and Modifier 33, the Medicare exclusion and its alternatives, common denial reasons with resolution steps, and the 2026 CMS and ICD-10 updates that directly affect preventive visit billing

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A second violation is a Class D Felony, if there has been a previous conviction within the last five years