Summary & Overview
CPT 99382: Initial Preventive Medicine Evaluation for New Pediatric Patients
CPT code 99382 represents the initial comprehensive preventive medicine evaluation and management for new patients, typically children in early childhood. This service encompasses a detailed history, physical examination, counseling, anticipatory guidance, risk factor reduction interventions, and the ordering of laboratory or diagnostic procedures. It is a cornerstone of preventive healthcare, supporting early detection and intervention for pediatric patients.
Major national payers such as Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare provide coverage for this code, reflecting its widespread adoption and importance in routine pediatric care. The publication offers insights into payer coverage, clinical context, and relevant policy updates for 99382. Readers will gain an understanding of how this code fits into preventive medicine workflows, its role in comprehensive child health assessments, and its relationship to other codes in the preventive medicine family. The summary also highlights common billing modifiers and associated provider taxonomies, equipping stakeholders with the information needed to navigate the evolving landscape of preventive medicine billing and coding.
CPT Code Overview
CPT code 99382 is used for the initial comprehensive preventive medicine evaluation and management of a new patient. This service includes an age and gender appropriate history, examination, counseling, anticipatory guidance, risk factor reduction interventions, and the ordering of laboratory or diagnostic procedures. The typical site of service for this code is the office setting (POS 11). This code is primarily utilized for preventive medicine visits for new patients, ensuring a thorough assessment and guidance to promote overall health and wellness.
Clinical & Coding Specifications
Clinical Context
A new patient, aged 1 through 4 years, presents to a pediatric, family medicine, or general practice office for an initial comprehensive preventive medicine evaluation. The visit includes a thorough age- and gender-appropriate history, physical examination, counseling on anticipatory guidance and risk factor reduction, and ordering of laboratory or diagnostic procedures as needed. The encounter may be for a routine child health examination, participation in sports, or admission to an educational or residential institution. The service is performed in an office setting and is documented as a preventive medicine visit for a new patient.
Coding Specifications
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Modifier
25: Used when a significant, separately identifiable evaluation and management service is performed by the same physician on the same day as another procedure or service. -
Modifier
33: Indicates that the service provided is a preventive service.
| Provider Taxonomy Code | Specialty |
|---|---|
208000000X | Pediatrics |
207Q00000X | Family Medicine |
208D00000X | General Practice |
Related Diagnoses
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Z00.129: Encounter for routine child health examination without abnormal findings- Used when the preventive visit reveals no abnormal findings.
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Z00.121: Encounter for routine child health examination with abnormal findings- Used when the preventive visit identifies abnormal findings.
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Z02.5: Encounter for examination for participation in sport- Used when the visit is for a sports participation clearance.
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Z02.0: Encounter for examination for admission to educational institution- Used when the visit is for school admission requirements.
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Z02.2: Encounter for examination for admission to residential institution- Used when the visit is for admission to a residential institution, such as a group home or boarding school.
Each diagnosis code is relevant for documenting the specific reason for the preventive medicine visit coded with 99382.
Related CPT Codes
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99381: Initial comprehensive preventive medicine evaluation and management of an individual, new patient; early childhood (age 1 through 4 years).- Closely related to
99382, but used for younger patients (age 1 through 4 years).
- Closely related to
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99392: Periodic comprehensive preventive medicine reevaluation and management of an individual, established patient; early childhood (age 1 through 4 years).- Used for established patients in the same age group for periodic preventive visits.
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99461: Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant.- Used for preventive care of newborns in hospital or birthing center settings, not office visits.
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99460: Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant.- Similar to
99461, used for newborns in hospital or birthing center settings.
- Similar to
These codes are alternatives or complements to 99382 depending on patient age, status (new vs. established), and site of service.
National Reimbursement Benchmarks
National mean rates for CPT code 99382 show that UnitedHealth Group has the highest average reimbursement at $157.43, while Aetna is the lowest among the major commercial payers at $113.08. The BUCA average (Blue Cross Blue Shield, UnitedHealth Group, Cigna, Aetna) stands at $124.93, notably higher than typical Medicare rates, though Medicare data is not available in the input for this code.
Rate dispersion varies significantly across payers. Aetna has the tightest range between the 25th and 75th percentiles ($50.30), indicating less variability in contracted rates. UnitedHealth Group exhibits the widest spread ($85.50), suggesting greater variability in reimbursement levels. Cigna and Blue Cross Blue Shield also show substantial dispersion, with ranges of $86.00 and $58.00, respectively.
The table and chart below present a detailed breakdown of national benchmarks for each payer, including mean rates and percentile values.
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