Summary & Overview
CPT 99381: Initial Preventive Medicine Evaluation for Infants Under 1 Year
CPT code 99381 represents the initial comprehensive preventive medicine evaluation and management for infants under one year of age. This code is a cornerstone of pediatric care, ensuring that newborns receive a thorough health assessment, including physical examination, developmental screening, and guidance for parents. The service is typically provided in an office setting and is essential for early detection of health issues and establishing a foundation for ongoing care.
Major national payers such as Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare recognize and reimburse for this preventive service. The publication provides an overview of payer coverage, clinical context, and relevant billing benchmarks for CPT code 99381. Readers will gain insight into policy updates, typical use cases, and the importance of preventive medicine visits for new patients in pediatric practice. The summary also highlights associated modifiers and related codes, offering a comprehensive look at billing and documentation requirements for this service. This information is valuable for understanding national trends in pediatric preventive care and ensuring accurate coding and reimbursement.
CPT Code Overview
CPT code 99381 is used for the initial comprehensive preventive medicine evaluation and management of an individual under 1 year of age. This service is classified as Preventive Medicine — New Patient and is typically performed in an office setting (Place of Service 11). The code covers a thorough assessment of a newborn's health, including history, examination, and anticipatory guidance, as part of routine pediatric care for infants during their first year of life.
Clinical & Coding Specifications
Clinical Context
A newborn infant, less than one year old, is brought by their parent or guardian to a pediatrician's office for an initial comprehensive preventive medicine evaluation. The visit includes a thorough assessment of the infant's health status, growth, and development, as well as a physical examination. The provider reviews the infant's medical history, performs age-appropriate screenings, and discusses preventive health measures with the family. This encounter is typically scheduled as the first well-child visit for a new patient in the practice, and takes place in an office setting (Place of Service 11).
Coding Specifications
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Modifiers:
+99358: Prolonged evaluation and management service before and/or after direct (face‑to‑face) patient care; first hour. Used when the provider spends additional time on the patient's care outside of the face-to-face encounter, such as reviewing records or coordinating care.+99359: Prolonged evaluation and management service; each additional 30 minutes. Used in conjunction with+99358when more than one hour of prolonged service is provided.
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Provider Taxonomies:
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