CPT 99383: New Patient Well-Child Visit, Ages 5–11
Commercial payers pay $127 on average nationally for this procedure.
CPT code 99383 describes an initial comprehensive preventive medicine evaluation and management visit for a new pediatric patient aged 5 through 11, performed as a well-child visit focusing on age-appropriate history, physical examination, anticipatory guidance, developmental screening, and preventive counseling; typical service type is a preventive medicine evaluation and the usual site of service is an outpatient clinic or physician office providing pediatric or family medicine care.
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National Reimbursement Benchmarks
Commercial rates for CPT 99383 cluster around BUCA’s average commercial rate of $127.10, with noticeable variation across major national payers. UnitedHealth Group shows the highest central tendency with a median of $143.20 and a relatively large upper tail, while Cigna and Aetna sit lower in central tendency (medians $119.50 and $107.00 respectively). Blue Cross Blue Shield’s median of $106.10 aligns close to Aetna, and BUCA’s median of $114.70 sits between BCBS and Cigna.
Dispersion measured by the interquartile spread (P75 minus P25) is widest for UnitedHealth Group at $91.50 ($200.30 - $108.80), indicating the broadest middle-50% range. Aetna and Cigna have similar spreads of $82.80 ($159.00 - $71.20) and $87.40 ($172.60 - $84.60) respectively. Blue Cross Blue Shield shows the tightest IQR at $36.30 ($136.10 - $89.80), while BUCA’s IQR is $67.70 ($156.70 - $89.00).