Summary & Overview
CPT 99384: Initial Preventive Visit for Adolescents
Headline: CPT 99384: Initial Preventive Visit for Adolescents
Lead: CPT 99384 denotes the initial comprehensive preventive medicine evaluation and management visit for a new adolescent patient (ages 12–17). This code captures a multi-component preventive encounter that combines history, examination, counseling/anticipatory guidance, risk-reduction interventions, and any ordering of appropriate laboratory or diagnostic tests in an outpatient office setting.
What this code represents and why it matters: As preventive services for adolescents gain emphasis, CPT 99384 is a central code for documenting and billing the first comprehensive preventive visit for new adolescent patients. Proper use supports clinical continuity, preventive screening, and population health initiatives aimed at immunization, mental health screening, and risk counseling during a key developmental window.
Key payers covered: The analysis covers national commercial payers including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare.
Overview of reader takeaways: Readers will find a concise description of the services represented by CPT 99384, payer coverage context, common billing considerations, and how this code fits among age-based initial preventive visit codes. The publication highlights clinical context for the adolescent preventive visit and operational notes relevant to outpatient practice workflows. Data not available in the input for service-line specifics and payer policy nuances is noted where applicable.
CPT Code Overview
CPT 99384 is an initial comprehensive preventive medicine evaluation and management service for a new patient who is an adolescent, age 12 through 17 years. The service includes an age- and gender-appropriate history, physical examination, counseling and anticipatory guidance, risk factor reduction interventions, and the ordering of laboratory or diagnostic procedures as appropriate.
Service Type: Preventive Medicine / Evaluation and Management
Typical Site of Service: Office (Outpatient) (POS 11)
Clinical & Coding Specifications
Clinical Context
A 14-year-old adolescent presents to an outpatient office visit with a new primary care provider for a comprehensive preventive health evaluation. The visit includes an age- and gender-appropriate medical, social, and developmental history; a focused physical examination; counseling and anticipatory guidance (nutrition, immunizations, mental health screening, risk-reduction counseling); and ordering of age-appropriate laboratory or diagnostic tests. Nursing staff may obtain vital signs and growth measurements before the clinician encounter. The clinician documents review of past medical records, immunization status, risk assessment, and formulates a preventive care plan. The encounter is coded as 99384 when the patient is a new patient aged 12 through 17 years undergoing an initial comprehensive preventive medicine evaluation.
Coding Specifications
Modifier 25
- Use when a significant, separately identifiable Evaluation and Management service is provided by the same physician on the same day as another procedure or service.
Modifier 33
- Use to indicate that the service is a preventive service.
Associated provider taxonomies
-
208000000X: Pediatrics Physician -
207Q00000X: Family Medicine Physician -
208D00000X: General Practice Physician
Related Diagnoses
Z00.121 - Routine child health examination with abnormal findings
- Indicates a preventive examination encounter in which the clinician documents abnormal findings identified during the routine child health evaluation; relevant when
99384includes assessment of identified abnormalities.
Z00.129 - Routine child health examination without abnormal findings
- Indicates a routine preventive visit with no abnormal findings noted during the child health examination; commonly paired with
99384for a standard preventive visit.
Related CPT Codes
99381 - Initial comprehensive preventive medicine evaluation and management of an individual; new patient; infant (age under 1 year)
- Used for infants; alternative by age to
99384.
99382 - Initial comprehensive preventive medicine evaluation and management of an individual; new patient; early childhood (age 1 through 4 years)
- Used for early childhood preventive visits; an age-based alternative to
99384.
99383 - Initial comprehensive preventive medicine evaluation and management of an individual; new patient; late childhood (age 5 through 11 years)
- Used for late childhood preventive visits; an age-based alternative to
99384.
99385 - Initial comprehensive preventive medicine evaluation and management of an individual; new patient; 18–39 years
- Used for adults beginning at age 18; an age-based alternative to
99384.
Relationship to 99384:
- The listed codes represent the same initial comprehensive preventive medicine service for different age ranges; they are alternatives to
99384based on patient age. These codes are not typically reported together for the same encounter; one code is selected according to the patient’s age.
National Reimbursement Benchmarks
National average commercial rates (BUCA) at $145.85 are meaningfully higher than Medicare (Data not available in the input.), and BUCA sits between the lower Aetna and BCBS means and the higher Cigna and UnitedHealth Group means. UnitedHealth Group posts the highest national mean at $182.50, while Aetna posts the lowest among reported commercial payers at $135.16.
Dispersion measured as the P75–P25 interpercentile gap is widest for UnitedHealth Group (220.67 − 122.00 = $98.67) and Cigna (204.50 − 101.20 = $103.30), indicating broader variability in allowed rates. The tightest spreads appear with BCBS (169.00 − 112.50 = $56.50) and Aetna (160.00 − 96.00 = $64.00). The table and chart below present the full breakdown.
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