CPT 99391: Preventive Medicine Visit, Early Childhood
Commercial payers pay $98 on average nationally for this procedure.
CPT code 99391 describes a comprehensive preventive medicine reevaluation and management visit for an early childhood patient who is not seeking care for an acute problem; the service includes a thorough review of systems, comprehensive past, family, and social history, assessment of age- and gender-related risk factors, formulation of a preventive plan, and may include ordering diagnostic tests and administering immunizations during a periodic health checkup typically delivered in an office or ambulatory clinic setting.
For related coverage guidance, see recent payer policy updates: DRG Newborn Inpatient Stays - Facility, Pediatric Preventive Screening, Pediatric Preventive Screening.
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National Reimbursement Benchmarks
For CPT 99391, national commercial rates center around BUCA’s mean of $98 as a representative average commercial benchmark. UnitedHealth Group posts the highest central tendency with a median of $117.90 and a mean of $132.40, while Cigna and Aetna sit slightly lower with medians of $101.80 and $96.00 and means of $115.30 and $112.60 respectively. Blue Cross Blue Shield’s mean of $81.40 and median of $78.80 fall below BUCA’s average commercial level, indicating a lower-cost position among major national payers.
Dispersion measured by the interquartile range (P75–P25) is narrowest for Blue Cross Blue Shield at $3.29 ($96.59–$59.30) and widest for Aetna at $89.00 ($155.00–$64.00), with UnitedHealth Group also showing a relatively wide spread of $76.70 ($165.50–$88.80). BUCA’s IQR is $55.28 ($121.90–$66.20) and Cigna’s is $69.00 ($146.00–$74.00). These differences highlight substantial variability in mid-market pricing between payers.