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CPT 99382: Initial Well-Child Visit, Age 1–4

CPT code 99382 denotes an initial comprehensive preventive medicine evaluation and management visit for a new pediatric patient aged 1 through 4 years. As the code captures the full well-child visit for early childhood, it is central to pediatric preventive care delivery and billing across outpatient settings nationally. Proper use of 99382 supports documentation of preventive services, age-appropriate counseling, developmental screening, and anticipatory guidance that are standard components of early childhood care.

Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. Readers will find concise context on the clinical purpose of the code, typical sites of service, commonly associated diagnosis pointers, and relationships to nearby preventive medicine codes for new and established patients. The publication outlines the code’s placement among related pediatric preventive codes and highlights common coding pairings used in outpatient practice.

This summary provides a national view of the code’s clinical role and administrative significance for practices and billing staff seeking clarity on service classification for new pediatric patients. Data not available in the input for payer-specific rates or utilization benchmarks is not included.

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Billing Code Overview

CPT code 99382 is used for a comprehensive preventive medicine evaluation and management visit for a new patient in early childhood (age 1 through 4 years). The service includes a full history, comprehensive physical examination, anticipatory guidance, and age-appropriate counseling and screening as part of a well-child visit.

Service type: Initial comprehensive preventive medicine evaluation and management

Typical site of service: Office or outpatient clinic visit for pediatric primary care

National Reimbursement Benchmarks

National commercial rates for CPT 99382 cluster around the BUCA average of $121.70, with payers showing meaningful variation around that level. UnitedHealth Group posts the highest central tendency (median $140) and a mean of $156, while Cigna and Blue Cross Blue Shield have medians of $115.20 and $102.20 with means of $128.50 and $111.20 respectively. Aetna’s mean is $111.80 and BUCA’s mean is $121.70. These figures place BUCA near the middle of the commercial spectrum rather than at an extreme. Dispersion measured by the interquartile range (P75–P25) is widest for Cigna at $84.90 (P75 $164.80 minus P25 $80.90) and UnitedHealth Group at $88.50 (P75 $194.00 minus P25 $105.50), indicating larger variability in commercial contract levels. Blue Cross Blue Shield and BUCA show tighter spreads: BCBS IQR is $42.90 (P75 $130.80 minus P25 $84.90) and BUCA IQR is $61.20 (P75 $150.00 minus P25 $84.80), while Aetna’s IQR is $61.10 (P75 $148.80 minus P25 $67.70), reflecting relatively moderate dispersion.

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CPT 99382: Initial Well-Child Visit, Age 1–4

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Billing Code Overview

Service type: Initial comprehensive preventive medicine evaluation and management

Typical site of service: Office or outpatient clinic visit for pediatric primary care

National Reimbursement Benchmarks

National Payer Mean Reimbursement Rates

Clinical & Coding Specifications

Clinical Context

A 2-year-old child presents as a new patient to a pediatric primary care clinic for a comprehensive well-child visit. The parent requests a routine health supervision visit, including growth and developmental assessment, anticipatory guidance, age‑appropriate immunizations, and screening for vision, hearing, and lead exposure. The visit is scheduled in an outpatient office setting with a board-certified pediatrician (taxonomy 208000000X) or family medicine physician (taxonomy 207Q00000X).

The clinical workflow: the family completes intake forms and a developmental screening tool in the waiting area. Nursing obtains vital signs, height, weight, and immunization history, and documents any allergies or medications. The provider performs a comprehensive history (birth, feeding, milestones, social determinants), a full physical examination, age‑appropriate screening (developmental, vision, hearing), reviews growth charts and immunization needs, counsels the parent on safety and nutrition, and documents findings. If no abnormal findings are present, diagnosis Z00.129 is typically recorded. If an abnormal finding is identified (for example developmental concern or growth issue), Z00.121 is used and the provider documents the abnormality and any planned follow‑up. If the visit is for school or sports clearance, Z02.5 or Z02.0/Z02.2 are used as appropriate. The visit is billed as 99382 for a new patient aged 1–4 years and coded with the appropriate ICD‑10 code reflecting normal or abnormal findings and any additional problem‑specific codes when applicable.

Coding Specifications

Modifier	Description	When to Use
`25`	Significant, separately identifiable E/M service on the same day as another procedure or service	Use when a distinct problem‑focused E/M is provided in addition to the preventive visit on the same day.
`59`	Distinct procedural service	Use to indicate a separate, distinct procedure performed the same day that is not typically part of `99382`.
`25`	Duplicate (listed above)	Duplicate entry omitted in practice; only one `25` instance should be billed.
`51`	Data not provided in the input.	Data not available in the input.
`26`	Professional component	Use when billing only the provider’s professional component of a service (rare for well visits).
`TC`	Technical component	Use when billing only the technical component of a service (rare for preventive office visit).
`59`	Duplicate (listed above)	Duplicate entry omitted in practice; only one `59` instance should be billed.
`52`	Reduced services	Use when the service provided is partially reduced or not completed (for example, limited exam due to patient behavior) and documentation supports the reduction.
`53`	Discontinued procedure	Use when the visit or a procedure performed during the visit was started but discontinued due to extenuating circumstances.
`25`	Duplicate (listed above)	Duplicate entry omitted in practice; only one `25` instance should be billed.

Taxonomy Code	Specialty	Notes
`208000000X`	Pediatrics	Primary specialty performing well‑child visits for ages 1–4.
`207Q00000X`	Family Medicine	Commonly provides pediatric preventive care in primary care settings.
`208D00000X`	General Practice	Provides preventive pediatric visits in some community settings.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z00.129`	Encounter for routine child health examination without abnormal findings	Used when the well‑child visit is normal with no abnormal findings documented; appropriate primary diagnosis for preventive service billing.
`Z00.121`	Encounter for routine child health examination with abnormal findings	Used when the well visit reveals abnormal findings (for example developmental delay or growth concern) that require documentation and possible additional services.
`Z02.5`	Encounter for examination for participation in sport	Used when the visit includes clearance or examination specific to sports participation requirements.
`Z02.0`	Encounter for examination for admission to educational institution	Used when the visit is performed for school admission physical requirements.
`Z02.2`	Encounter for examination for admission to residential institution	Used when the preventive exam is required for admission to a residential setting.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99381`	Initial comprehensive preventive medicine evaluation and management of an individual, new patient; infancy (younger than 1 year)	Alternative new‑patient preventive visit for younger age group; used when the patient age falls under infancy instead of early childhood.
`99392`	Periodic comprehensive preventive medicine reevaluation and management of an individual, established patient; early childhood (age 1 through 4 years)	Follow‑up preventive visit for established patients in the same age range; used for routine periodic well visits after initial new‑patient visit.
`99461`	Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant	Related newborn inpatient initial care code; relevant earlier in the continuum of pediatric preventive care for neonates.
`99460`	Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant	Related inpatient newborn care code used at birth prior to outpatient preventive care.

CPT 98000: New Patient Telemedicine E/M Visit, Straightforward or ≥15 Minutes

CPT-98001-NEW-PATIENT-VIDEO-EVALUATION-30-MINUTES-LOW-MDM

CPT 98001: New Patient Telehealth E/M, Low MDM or ≥30 Minutes

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

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Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`25`	Significant, separately identifiable E/M service on the same day as another procedure or service	Use when a distinct problem‑focused E/M is provided in addition to the preventive visit on the same day.
`59`	Distinct procedural service	Use to indicate a separate, distinct procedure performed the same day that is not typically part of `99382`.
`25`	Duplicate (listed above)	Duplicate entry omitted in practice; only one `25` instance should be billed.
`51`	Data not provided in the input.	Data not available in the input.
`26`	Professional component	Use when billing only the provider’s professional component of a service (rare for well visits).
`TC`	Technical component	Use when billing only the technical component of a service (rare for preventive office visit).
`59`	Duplicate (listed above)	Duplicate entry omitted in practice; only one `59` instance should be billed.
`52`	Reduced services	Use when the service provided is partially reduced or not completed (for example, limited exam due to patient behavior) and documentation supports the reduction.
`53`	Discontinued procedure	Use when the visit or a procedure performed during the visit was started but discontinued due to extenuating circumstances.
`25`	Duplicate (listed above)	Duplicate entry omitted in practice; only one `25` instance should be billed.

Taxonomy Code	Specialty	Notes
`208000000X`	Pediatrics	Primary specialty performing well‑child visits for ages 1–4.
`207Q00000X`	Family Medicine	Commonly provides pediatric preventive care in primary care settings.
`208D00000X`	General Practice	Provides preventive pediatric visits in some community settings.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`Z00.129`	Encounter for routine child health examination without abnormal findings	Used when the well‑child visit is normal with no abnormal findings documented; appropriate primary diagnosis for preventive service billing.
`Z00.121`	Encounter for routine child health examination with abnormal findings	Used when the well visit reveals abnormal findings (for example developmental delay or growth concern) that require documentation and possible additional services.
`Z02.5`	Encounter for examination for participation in sport	Used when the visit includes clearance or examination specific to sports participation requirements.
`Z02.0`	Encounter for examination for admission to educational institution	Used when the visit is performed for school admission physical requirements.
`Z02.2`	Encounter for examination for admission to residential institution	Used when the preventive exam is required for admission to a residential setting.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99381`	Initial comprehensive preventive medicine evaluation and management of an individual, new patient; infancy (younger than 1 year)	Alternative new‑patient preventive visit for younger age group; used when the patient age falls under infancy instead of early childhood.
`99392`	Periodic comprehensive preventive medicine reevaluation and management of an individual, established patient; early childhood (age 1 through 4 years)	Follow‑up preventive visit for established patients in the same age range; used for routine periodic well visits after initial new‑patient visit.
`99461`	Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant	Related newborn inpatient initial care code; relevant earlier in the continuum of pediatric preventive care for neonates.
`99460`	Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant	Related inpatient newborn care code used at birth prior to outpatient preventive care.

CPT 98000: New Patient Telemedicine E/M Visit, Straightforward or ≥15 Minutes

CPT-98001-NEW-PATIENT-VIDEO-EVALUATION-30-MINUTES-LOW-MDM

CPT 98001: New Patient Telehealth E/M, Low MDM or ≥30 Minutes

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

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CPT 99382: Initial Well-Child Visit, Age 1–4

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Billing Code Overview

National Reimbursement Benchmarks

OpenPayer

CPT 99382: Initial Well-Child Visit, Age 1–4

Sign up for cpt 99382 policy alerts

Billing Code Overview

National Reimbursement Benchmarks

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References