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CPT 99391: Preventive Medicine Visit, Early Childhood (0–11 Months)
CPT code 99391 designates a comprehensive preventive medicine reevaluation and management visit for an established patient in early childhood (age 0 through 11 months). These well-child visits focus on development, growth monitoring, immunizations, anticipatory guidance, and identification of age- and gender-related risk factors. Nationally, preventive pediatric visits remain a cornerstone of population health and early intervention, with implications for immunization coverage, developmental screening, and long-term health outcomes.
This analysis covers major national payers including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical intent of the code, typical sites of service, common payer coverage considerations, and how 99391 relates to adjacent periodic preventive CPT codes for other pediatric and adult age ranges. The content highlights what to expect in service components—comprehensive review of systems, comprehensive PFSH, diagnostic/laboratory ordering, and immunizations—so stakeholders understand clinical documentation and coding context. Data not available in the input for payer-specific reimbursement rates and utilization benchmarks is indicated where relevant.
Intended readers include clinicians, billing and coding specialists, and policy analysts seeking a concise reference on the clinical scope and payer landscape for CPT code 99391 at the national level.
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Billing Code Overview
CPT code 99391 describes a preventive medicine reevaluation and management service for an established patient in early childhood (age 0 through 11 months). The service is a periodic health checkup provided to individuals who are not currently seeking care for an acute problem but require routine preventive assessment. The physician performs a comprehensive review of systems, obtains a comprehensive past, family, and social history (PFSH), assesses age- and gender-related risk factors, and may order diagnostic or laboratory tests and administer immunizations as part of the preventive visit.
Service type: Preventive medicine — periodic comprehensive preventive medicine reevaluation and management (established patient, early childhood)
Typical site of service: Outpatient clinic or office-based primary care setting, including pediatric or family medicine offices where routine well-child visits and immunizations are administered.
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.