Summary & Overview
CPT 99170: Forensic Pediatric Sexual Abuse Examination with Microscopy
CPT code 99170 describes a focused forensic examination of a child’s genital and anal areas using microscopy and potential image recording when sexual abuse or assault is suspected. This code captures a specialized clinical-forensic service that supports medical care, documentation of injury, and evidence collection — making it important for clinical management, legal processes, and payer coverage determinations nationwide. Key national payers relevant to coverage and reimbursement for this service include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical purpose and typical settings for the service, the payer landscape included in this analysis, and guidance on the kinds of benchmarks and policy considerations typically addressed for this code. The publication summarizes common modifiers associated with billing for specialized examinations and notes when additional documentation or site-specific policies may influence reimbursement. It also outlines clinical context — forensic pediatric evaluation using microscopy and image capture — and identifies where data is not available in the input. The focus is national in scope and intended for providers, billing professionals, and policy analysts seeking a clear, practical reference on CPT code 99170 and its role in documenting pediatric sexual abuse evaluations.
Billing Code Overview
CPT code 99170 documents a focused forensic examination of a child's genitals and anal area using microscopy and, when appropriate, image recording. This service is performed when a child is suspected of having been sexually abused or assaulted and is intended to document physical findings that may have forensic and clinical relevance.
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Service Type: Forensic pediatric sexual abuse examination
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Typical Site of Service: Hospital outpatient department, emergency department, or specialized forensic clinic where microscopy and image capture are available
Clinical & Coding Specifications
Clinical Context
A 6-year-old female presents to a pediatric forensic clinic after a disclosure of possible sexual assault by a non-family acquaintance. The presenting complaint includes genital discomfort and a caregiver report of concerning behavioral changes. The clinical workflow begins with triage and urgent medical evaluation, including history, consent from guardians, and assessment for lifesaving interventions and STI prophylaxis needs. A specialized clinician (pediatric emergency physician or sexual assault forensic examiner) performs a focused forensic genital and anal examination using magnification/microscopy and documents findings with clinical notes and, when indicated and permitted, image capture for evidentiary purposes. Chain-of-custody procedures are followed if a forensic evidence kit is collected. Post-exam steps include documentation of findings, specimen handling per protocol, provision of medical treatment as indicated, counseling for the patient and family, and coordination with child protective services and law enforcement as required by jurisdictional law.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier—standard billing indicator | Use when no specific modifier applies and service is reported as rendered by the billing provider. |
11 |