Modifier 25
CPT Guidelines for Preventive Medicine Services state "If an abnormality is encountered or a preexisting problem is addressed in the process of performing this preventive medicine evaluation and management service, AND IF the problem or abnormality is significant enough to require additional work to perform the key components of a problem-oriented E/M service, then the appropriate Office/Outpatient code 99201-99215 should also be reported. Modifier 25 should be added to the Office/Outpatient code to indicate that a significant, separately identifiable evaluation and management service was provided on the same day." Also, "the 'comprehensive' nature of the Preventive Medicine Services codes 99381-9937 reflects an age and gender appropriate history/exam and is not synonymous with the 'comprehensive' examination required in Evaluation and Management codes 99201-99350."
Therefore, with regards to the preventive E/M service, you should not be concerned with HPI, ROS and MDM. As for Modifier 59, it is used to "indicate that a procedure or service was distinct or independent from other non-E/M services performed on the same day" and for "other than E/M services, that are not normally reported together, but are appropriate under the circumstances." Modifier 59 should be your modifier of last resort.
Here is how I would code your scenario:
99202-25
99382-EP,25
90460-EP
90461-EP
The EP modifier is used to denote services provided as part of a Medicaid EPSDT service and may not be required by all payers. However, it is usually required for state Medicaid/CMO payers. With Georgia Medicaid/CMO payers, we also have to add the EP modifier after the modifier 25 on the Office Visit.
I hope this helps.