Summary & Overview
CPT 99383: Preventive Medicine Evaluation for New Pediatric Patients (Ages 5–11)
CPT code 99383 represents the initial comprehensive preventive medicine evaluation and management for new pediatric patients aged 5–11 years. This code is a cornerstone of preventive healthcare, enabling providers to deliver thorough assessments, counseling, and risk reduction interventions tailored to children in this age group. The service is typically performed in office or outpatient settings and is essential for early identification of health concerns and promotion of wellness.
Major national payers, including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, recognize and reimburse for CPT code 99383, underscoring its widespread adoption and importance in pediatric preventive medicine. This publication provides an overview of clinical context, payer coverage, and policy benchmarks relevant to this code. Readers will gain insight into the scope of services included, payer-specific considerations, and recent policy updates affecting preventive medicine billing for new pediatric patients.
The analysis also highlights related codes, common modifiers, and associated provider taxonomies, offering a comprehensive resource for understanding the role of CPT code 99383 in pediatric practice. This summary is designed to inform healthcare professionals, administrators, and policy stakeholders about the national landscape for preventive medicine services for children.
CPT Code Overview
CPT code 99383 is used for the initial comprehensive preventive medicine evaluation and management of a new patient who is a child aged 5–11 years. This service includes 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 an office or other outpatient setting, designated as POS 11. This code is central to preventive care for children, supporting early detection and health promotion during a critical developmental period.
Clinical & Coding Specifications
Clinical Context
A child aged 5–11 years presents as a new patient to a pediatric, family medicine, or general practice physician for an initial comprehensive preventive medicine evaluation. The visit occurs in an office or outpatient setting. The clinical workflow includes obtaining a detailed medical and social history, performing a thorough physical examination, providing age-appropriate counseling and anticipatory guidance, addressing risk factor reduction, and ordering any necessary laboratory or diagnostic tests. The encounter may also include documentation for school, sports participation, or admission to educational or residential institutions, depending on the patient's needs.
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 preventive in nature.
| Modifier Code | Description |
|---|---|
25 | Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service |