Summary & Overview
CPT 99391: Preventive Medicine Visit for Established Infant Patients
CPT code 99391 represents a periodic comprehensive preventive medicine reevaluation and management visit for established infant patients under one year of age. This code is a cornerstone of pediatric preventive care, ensuring infants receive thorough health assessments, counseling, and appropriate immunizations during their first year. Nationally, this service is recognized as essential for early detection of health issues and for promoting healthy development in children.
Major commercial payers, including Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare, provide coverage for services billed under CPT code 99391. The publication offers insights into payer coverage, clinical benchmarks, and policy updates relevant to preventive medicine visits for infants. Readers will gain an understanding of the clinical context for this code, including its role in routine child health examinations, and learn about associated billing practices, common modifiers, and related codes for other age groups. The summary also highlights the importance of preventive medicine services in the broader healthcare landscape, emphasizing their value in supporting child health and wellness.
This article is designed for healthcare professionals, billing specialists, and policy analysts seeking a comprehensive overview of CPT code 99391, including payer coverage, clinical guidelines, and billing considerations for preventive medicine services in pediatric care.
CPT Code Overview
CPT code 99391 is used for periodic comprehensive preventive medicine reevaluation and management of an established patient who is an infant (age younger than 1 year). This service includes an age and gender appropriate history, examination, counseling, anticipatory guidance, risk factor reduction interventions, and the ordering of appropriate immunizations, laboratory, or diagnostic procedures. The typical site of service for this code is the office setting (Place of Service 11). This code is part of preventive medicine services for established patients, focusing on early childhood health maintenance and disease prevention.
Clinical & Coding Specifications
Clinical Context
A typical scenario for CPT code 99391 involves an established infant patient, younger than 1 year, presenting to a primary care office for a periodic preventive medicine visit. The clinical workflow includes obtaining an age-appropriate medical history, performing a comprehensive physical examination, providing counseling and anticipatory guidance to the parent or guardian, addressing risk factor reduction, and ordering appropriate immunizations and laboratory or diagnostic procedures as indicated. The visit is focused on health maintenance and early detection of potential issues, rather than management of acute or chronic illness.
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. This may apply if, during the preventive visit, an additional E/M service is provided. -
Modifier
33: Indicates that the service provided is preventive in nature. This modifier is used to identify preventive services for payors, including Blue Cross Blue Shield, Cigna Health, Aetna, UnitedHealthcare, BUCA, and Medicare.
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