Summary & Overview
CPT 99392: Preventive Medicine Reevaluation for Early Childhood, Established Patient
CPT code 99392 represents a comprehensive preventive medicine reevaluation and management service for established pediatric patients aged 1 through 4 years. This code is nationally significant as it supports routine child health examinations, which are critical for early detection of health issues, developmental monitoring, and providing families with anticipatory guidance and risk factor reduction strategies. The service is typically delivered in an office setting and is a cornerstone of pediatric and family medicine practices.
Major payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare. The publication provides an overview of payer coverage, policy updates, and clinical context for the use of 99392. Readers will gain insights into billing benchmarks, relevant modifiers, associated taxonomies, and common ICD-10 diagnoses linked to this preventive service. The article also highlights related CPT codes for vision and hearing screening, as well as office visits when both well and sick visits are reported.
This summary equips healthcare professionals, billing specialists, and policy analysts with a clear understanding of the clinical and administrative aspects of 99392, supporting informed decision-making in preventive pediatric care.
CPT Code Overview
CPT code 99392 is used for periodic comprehensive preventive medicine reevaluation and management of an established patient in early childhood, specifically ages 1 through 4 years. 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 (Place of Service 11). These preventive medicine services are essential for monitoring child health, development, and providing guidance to families during early childhood.
Clinical & Coding Specifications
Clinical Context
A 2-year-old child, established with the practice, presents to the office for a routine early childhood preventive medicine visit. The provider conducts a comprehensive age-appropriate history and physical examination, offers counseling and anticipatory guidance to the parent regarding nutrition, safety, and developmental milestones, and orders recommended laboratory or diagnostic tests as indicated. The visit is focused on preventive care and does not address acute illness. If a separate, significant issue is addressed during the same encounter, an additional evaluation and management service may be reported with modifier 25.
Coding Specifications
- Modifier
25: Used when a significant, separately identifiable evaluation and management (E/M) service is performed by the same physician on the same day as the preventive medicine service. For example, if the child is seen for a preventive visit and also evaluated for an acute illness, modifier25is appended to the sick visit code.
| Provider Taxonomy Code | Specialty |
|---|---|
208000000X | Pediatrics |