CPT 99381: Well-Baby Visit for Infant Under One
Commercial payers pay $116 on average nationally for this procedure.
CPT code 99381 describes a well-baby preventive care visit for an infant under one year of age, representing an initial comprehensive preventive evaluation and management service typically delivered in an office or outpatient clinic setting and focused on growth assessment, developmental screening, immunization review, and parental counseling during the first year of life.
For related coverage guidance, see recent payer policy updates: Prolonged Services for Labor Management, Prolonged Services for Labor Management, Cervical Cancer Screening.
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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.