August 21, 2025
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.
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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.
CPT 99381 is a preventive medical evaluation code for new pediatric patients from birth through 1 year old. It covers history, exam, and anticipatory guidance.
CPT 99381 is used for infants from birth up to, but not including, age 1 year. For older pediatric patients, use 99382–99385.
99381 is for new patients; 99391 is for established patients in the same age group.
Yes, if a separate E/M service is performed, you can bill it with a sick visit code using modifier 25.
You need a complete patient history, physical exam, developmental milestones assessment, and counseling notes for preventive care.
Using the correct code ensures accurate reimbursement and prevents denials due to age mismatch or incomplete documentation.
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