In pediatric healthcare, preventive visits play an important role in monitoring a child’s growth, development, and overall well-being. Two key CPT codes commonly used for these visits are CPT code 99381 and CPT code 99391.
Understanding when and how to use these codes ensures accurate documentation and proper reimbursement for healthcare providers.
99381 CPT codes are used for a complete preventive medicine evaluation and management of a new pediatric patient. This code applies to newborns, children, and adolescents who are visiting a provider for the first time for a well-child exam.
By using the correct preventive CPT code, providers can ensure that these vital services are properly documented and reimbursed.
Unlike CPT 99381, CPT code 99391 is used for periodic complete preventive medicine reevaluation and management of an established patient who is an infant (under 1 year old).
This code applies to follow-up well-child visits, ensuring continued monitoring of an infant’s health.
Routine well-baby visits using CPT 99391 help to track the growth of an infant, quickly recognize potential health concerns, and provide parents with essential guidance on nutrition, safety, and development milestones.
Accurately apply 99381 CPT code and 99391 CPT code ensures that providers receive appropriate reimbursement while maintaining thorough records of pediatric preventive care. These codes are part of the broader preventive medicine CPT code range (99381–99429), which covers various age groups and patient types.
For providers, staying updated on the 99391 and 99397 fee schedules is essential for maximizing reimbursement while ensuring compliance with payer guidelines.
Preventive pediatric trips are fundamental for long -term health. Whether the use of CPT 99381 for new patients or CPT 99391 for installed infants, appropriate coding supports comprehensive care, while providers are compensated for their services.
Understanding these codes helps to streamline medical billing procedures, which benefits healthcare professionals and the families they serve.
As a mom of two, I learned that CPT code 99381 is typically billed for your child’s very first well-child visit. It covers a comprehensive preventive exam for new patients under the age of 1 year. That includes growth tracking, vaccinations, and developmental screening basically, a complete check to ensure your baby’s off to a healthy start.
CPT 99391 is for established patients kids who’ve already been seen before at the clinic. For example, if your child is coming in for their 1-year or 2-year well visit and you’re returning to the same pediatrician, 99391 is the code the doctor’s office uses for billing.
From experience as a parent and billing professional, I recommend following the AAP Bright Futures schedule these are typically yearly visits after age 2. CPT 99391 is used at each of those checkups to monitor your child’s physical and emotional development, check vision and hearing, and keep immunizations up to date.
I’ve sat through dozens of these as both a billing specialist and a mom. The visit usually includes:
Yes, absolutely. But here’s the thing I always tell parents: the vaccine itself and its administration might be billed separately using codes like 90460 or 90471. So even though the preventive visit may be fully covered, you could get a bill if your insurance doesn’t fully cover the shots. Always check your plan’s vaccine coverage.
Preventive visits (99381/99391) are about keeping your child healthy. Sick visits are when your child isn’t feeling well fever, rash, cough, etc.—and they’re billed under entirely different codes like 99213 or 99214.
I’ve seen parents frustrated when they thought a visit would be covered as preventive but turned into a sick visit—so be sure to clarify with your doctor’s office when you book the appointment.
Yes 99381 is for new patients from birth up to 1 year, and 99391 is for established patients under 1 year. As your child grows, you’ll see other age-based codes used (like 99382 for ages 1–4, 99392 for follow-ups in that range, etc.). It helps providers track development milestones by age bracket.
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