Summary & Overview
CPT 99393: Preventive Medicine Visit for Established Child (Ages 5-11)
CPT code 99393 represents a comprehensive preventive medicine reevaluation and management service for established patients in late childhood, ages 5 through 11 years. This code is widely used across the United States to support routine child health examinations, including history-taking, physical assessment, counseling, and risk factor reduction. The service is typically delivered in an office setting and is a cornerstone of pediatric and family medicine practices, ensuring children receive age-appropriate preventive care.
Major national payers such as Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare provide coverage for services billed under CPT code 99393. The publication offers insights into payer policies, clinical benchmarks, and recent updates relevant to preventive medicine billing. Readers will gain a clear understanding of the clinical context for this code, including its role in routine child health maintenance, and learn about associated billing practices, common modifiers, and related codes. The summary also highlights the importance of preventive medicine in improving health outcomes for children and outlines the key ICD-10 diagnoses commonly linked to this service. This resource is designed to inform healthcare professionals, administrators, and policy analysts about the national landscape for CPT code 99393.
CPT Code Overview
CPT code 99393 is used for periodic comprehensive preventive medicine reevaluation and management of an established patient in late childhood, specifically ages 5 through 11 years. This service includes an age and gender appropriate history, physical examination, counseling, anticipatory guidance, risk factor reduction interventions, and the ordering of laboratory or diagnostic procedures as needed. The typical site of service for this code is an office setting, such as a non-facility location (Place of Service 11). These preventive medicine services are essential for monitoring child health, supporting early intervention, and promoting overall wellness during late childhood.
Clinical & Coding Specifications
Clinical Context
A child aged 5 to 11 years visits a pediatrician or family medicine provider at an office setting for a routine annual check-up. The provider conducts a comprehensive preventive medicine reevaluation, including an age-appropriate history, physical examination, anticipatory guidance, counseling on risk factor reduction, and orders any necessary laboratory or diagnostic tests. The visit may also address specific needs such as clearance for sports participation or school admission, and may include dietary counseling if indicated. The patient is an established patient, meaning they have previously received care from the provider or practice.
Coding Specifications
-
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 Name |
|---|---|
208000000X | Pediatrics |