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CPT 99381: Well–Baby Visit for Infant Under One
CPT code 99381 designates a preventive well–baby visit for infants under one year of age. This early-life preventive encounter focuses on growth and developmental assessment, immunization planning, feeding and nutrition counseling, and parental anticipatory guidance—services that support long-term child health and help identify early concerns. Nationally, well-child visits are a core component of pediatric care delivery and preventive health metrics, influencing quality measurement and care continuity for infants.
Key payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The review provides readers with a concise clinical and billing profile of CPT code 99381, outlines common presentation and sites of service, and highlights operational considerations relevant to practice and payer interactions.
Readers will learn: the clinical context for use of CPT code 99381, the typical setting for service delivery, associated diagnosis contexts for well-infant exams, and related prolonged service codes that may accompany extended encounters. The summary also points to payer coverage considerations and common billing practices for preventive infant visits. Data not available in the input is noted where applicable.
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Billing Code Overview
CPT code 99381 describes a well–baby visit for a child under the age of one. This service is a preventive pediatric evaluation that includes assessment of growth, development, nutrition, immunization needs, anticipatory guidance, and parental counseling.
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Service type: Preventive well-child visit
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Typical site of service: Outpatient office or clinic (pediatric primary care setting)
National Reimbursement Benchmarks
Commercial contracted rates for CPT 99381 cluster centering around the BUCA average of $116.00 show meaningful dispersion across major payers. UnitedHealth Group posts the highest central tendency with a median of $131.90 and a P75–P25 spread of $84.00 (P75 $184.00 minus P25 $99.10), indicating the widest middle dispersion. Cigna and Aetna display similar medians ($108.80 and $99.90, respectively) but different spreads: Cigna’s P75–P25 is $79.80 (P75 $156.20 minus P25 $75.40) and Aetna’s is $89.30 (P75 $154.70 minus P25 $64.00), both wider than Blue Cross Blue Shield’s dispersion.
Blue Cross Blue Shield shows the tightest middle distribution with a P75–P25 spread of $46.41 (P75 $124.50 minus P25 $79.59), suggesting more consistency around its median of $96.20. BUCA as the average commercial benchmark sits between these payers at $116.00 with an interquartile perspective (P25 $79.50, P50 $104.90, P75 $144.70) that reflects a moderate spread of $65.20, positioning it closer to the market midpoint than the outlying wider distributions.