CPT 99392: Preventive Medicine Periodic Reevaluation, Pediatric/Adolescent

Commercial payers pay $105 on average nationally for this procedure.

CPT code 99392 describes a preventive medicine periodic reevaluation and management service for pediatric and adolescent patients that includes a comprehensive review of systems, thorough past, family, and social history, assessment of age- and gender-related risk factors, and may include ordering diagnostic/laboratory tests and administering immunizations; service type: preventive medicine periodic reevaluation and management; typical site of service: outpatient office or clinic (well-child/well-adolescent visit).

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

Commercial reimbursement for CPT 99392 clusters around BUCA’s average commercial rate of $105.20, with notable dispersion among individual payers. UnitedHealth Group and Cigna sit above BUCA on mean and median values, while Blue Cross Blue Shield and Aetna show wider spread between lower and higher payments. BUCA’s distribution (P25 $71.20 to P75 $130.80) positions it near the market center.

Measuring interquartile dispersion (P75 minus P25) highlights differences in rate consistency: Blue Cross Blue Shield has the tightest IQR at $40.70, indicating relatively consistent midrange payments; Aetna’s IQR is $96.10 and Cigna’s is $74.10, both showing broader mid-market variability. UnitedHealth Group’s IQR of $81.90 also reflects substantial spread, suggesting greater mid-tier rate variation compared with Blue Cross Blue Shield.

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CPT 99392: Preventive Medicine Periodic Reevaluation, Pediatric/Adolescent

Commercial payers pay $105 on average nationally for this procedure.

For related coverage guidance, see recent payer policy updates: DRG Newborn Inpatient Stays - Facility, Pediatric Preventive Screening, Pediatric Preventive Screening.

Customize your policy alerts

Sign up for cpt 99392 policy alerts

Get alerted when payer policies referencing 99392 are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

National Reimbursement Benchmarks

National Payer Mean Reimbursement Rates

Clinical & Coding Specifications

Clinical Context

A 6-year-old child presents to a pediatric clinic for an annual well-child visit billed with 99392 (preventive medicine reevaluation and management, established patient; early childhood). The clinical workflow begins with medical assistant intake: height, weight, vital signs, immunization review, and a standardized developmental screening. The clinician performs a comprehensive review of systems, documents a comprehensive past, family, and social history (PFSH), updates growth and immunization records, conducts a full physical exam emphasizing age-appropriate systems, assesses age- and gender-related risk factors, and documents anticipatory guidance. Vision and hearing screenings may be performed by ancillary staff; if separately billable, they are documented with their respective codes. Laboratory or diagnostic orders (for example, lead screening, hemoglobin) are placed as indicated. If a concurrent problem visit occurs during the same encounter (e.g., acute otitis media), the clinician documents the additional problem-focused history, exam, and medical decision-making and appends modifier 25 to the appropriate established patient E/M code to indicate a significant, separately identifiable evaluation and management service on the same day as the preventive visit. Typical payors for this service include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthCare, BUCA, and Medicare. Typical sites of service are office/outpatient primary care clinics, pediatric practices, school-based health centers, and community clinics.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99212–99215`	Office or other outpatient established patient visits	Used when both well and sick visits occur same day; the problem-focused E/M is reported in addition to `99392` with modifier `25`

99173 | Vision screen, automated, unilateral or bilateral, with interpretation and report | Vision screening frequently performed during well-child visits but billed separately from 99392 when payor requires distinct reporting

92551 | Screening test, pure tone, air only | Hearing screening commonly performed during preventive pediatric visits and reported separately when applicable

Related Modifiers

9 rows

Modifier	Description	When to Use
25	CPT modifier 25 indicates that on the same day as another procedure or service, the same physician or other qualified health care professional provided a significant, separately identifiable…	- When to apply: Use modifier 25 only on an E/M code to indicate the same provider delivered a significant, separately identifiable E/M service on the same day as another procedure or service — i.e.,…
26	Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…	- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
59	Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…	- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
33	Modifier 33 was created by the American Medical Association in response to the Affordable Care Act to identify services provided for preventive intent. It is appended to CPT/HCPCS codes that could be…	- Use modifier -33 when a CPT/HCPCS service that can be billed as either preventive or diagnostic/treatment is provided with preventive intent and aligns with USPSTF A or B recommendations or other…
50	Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…	- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
95	Modifier 95 indicates that a service was provided via synchronous, real‑time audio‑video telehealth rather than in‑person. Per CMS, AAPC and professional associations, append modifier 95 to claim…	- Use modifier 95 to indicate a service was furnished via synchronous, real‑time audiovisual telehealth (a live audio‑video conference between patient and provider) rather than in‑person. - Pair…
22	Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…	- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
57	CPT® modifier -57 (“Decision for Surgery”) is appended to an Evaluation and Management (E/M) service when that encounter results in the initial decision to perform a major surgery (a procedure with a…	- Use modifier 57 when an E/M service provided by the same provider (or same tax ID) on the day of or the day before a major surgical procedure (90‑day global period) results in the initial decision…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
208000000X	Pediatrics Physician	A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectru…
207Q00000X	Family Medicine Physician	Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadt…
208D00000X	General Practice Physician	A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.
111NI0013X	Independent Medical Examiner Chiropractor	A special evaluator not involved with the medical care of the individual examinee that impartially evaluates the care being provided by other practiti…
174400000X	Specialist	An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond…
2085N0904X	Nuclear Radiology Physician	A radiologist who is involved in the analysis and imaging of radionuclides and radiolabeled substances in vitro and in vivo for diagnosis and the admi…
3336S0011X	Specialty Pharmacy	A pharmacy that dispenses generally low volume and high cost medicinal preparations to patients who are undergoing intensive therapies for illnesses t…
172P00000X	Naprapath	Naprapathy means a branch of medicine that focuses on the evaluation and treatment of neuron-muscular conditions. Doctors of naprapathy are connectiv…

Related ICD-10-CM Codes

24 rows

ICD-10-CM Code	Description
Z00.00	Encounter for general adult medical examination without abnormal findings
Z00.01	Encounter for general adult medical examination with abnormal findings
Z00.110	Health examination for newborn under 8 days old
Z00.111	Health examination for newborn 8 to 28 days old
Z00.121	Encounter for routine child health examination with abnormal findings
Z00.129	Encounter for routine child health examination without abnormal findings
Z00.2	Encounter for examination for period of rapid growth in childhood
Z00.3	Encounter for examination for adolescent development state
Z00.5	Encounter for examination of potential donor of organ and tissue
Z00.6	Encounter for examination for normal comparison and control in clinical research program

Showing 1–10 of 24

Related Payer Policy Updates

Specialty: Pediatrics/Neonatology1 / 2

10 rows

Policy	Payer	Effective Date
DRG Newborn Inpatient Stays - Facility	Blue Cross Blue Shield - Maine	2026-10-01
Pediatric Preventive Screening	Oscar Health	2026-10-01
Pediatric Preventive Screening	Blue Cross Blue Shield - New Mexico	2026-09-04
Pediatric Oral Function Therapy	Ambetter Georgia	2026-08-01
Prescribed Pediatric Extended Care (for Kentucky Only)	UnitedHealthcare	2026-08-01
Pediatric Preventive Screening	blue cross blue shield - louisiana	2026-08-01
Pediatric Oral Function Therapy	Health Net	2026-08-01
Pediatric Oral Function Therapy (Coverage Criteria)	Ambetter Nevada	2026-08-01
Pediatric Oral Function Therapy	Arizona Complete Health	2026-08-01
Pediatric Oral Function Therapy	Health Net	2026-08-01

CPT 98004: Established Patient Telemedicine E/M Visit, 10+ Minutes

CPT-98006-ESTABLISHED-PATIENT-AUDIO-VIDEO-EVALUATION-MANAGEMENT-30MIN

CPT 98006: Established Patient Telemedicine E/M, Moderate Complexity

CPT-98007-ESTABLISHED-PATIENT-TELEHEALTH-HIGH-COMPLEXITY-40-MIN

CPT 98007: Established Patient E/M via Synchronous Audio–Video, High MDM

Frequently Asked Questions

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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Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

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Clinical & Coding Specifications

Clinical Context

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`99212–99215`	Office or other outpatient established patient visits	Used when both well and sick visits occur same day; the problem-focused E/M is reported in addition to `99392` with modifier `25`

92551 | Screening test, pure tone, air only | Hearing screening commonly performed during preventive pediatric visits and reported separately when applicable

Related Modifiers

9 rows

Modifier	Description	When to Use
25	CPT modifier 25 indicates that on the same day as another procedure or service, the same physician or other qualified health care professional provided a significant, separately identifiable…	- When to apply: Use modifier 25 only on an E/M code to indicate the same provider delivered a significant, separately identifiable E/M service on the same day as another procedure or service — i.e.,…
26	Modifier 26 (Professional Component) identifies and bills only the professional portion of a split service — the physician’s interpretation, report, and medical judgment — when the technical…	- Use CPT Modifier -26 when you are billing only the professional component (PC) of a split‑bill eligible service—i.e., you performed the physician interpretation, medical judgment and prepared a…
59	Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…	- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
52	Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…	- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
33	Modifier 33 was created by the American Medical Association in response to the Affordable Care Act to identify services provided for preventive intent. It is appended to CPT/HCPCS codes that could be…	- Use modifier -33 when a CPT/HCPCS service that can be billed as either preventive or diagnostic/treatment is provided with preventive intent and aligns with USPSTF A or B recommendations or other…
50	Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…	- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…
95	Modifier 95 indicates that a service was provided via synchronous, real‑time audio‑video telehealth rather than in‑person. Per CMS, AAPC and professional associations, append modifier 95 to claim…	- Use modifier 95 to indicate a service was furnished via synchronous, real‑time audiovisual telehealth (a live audio‑video conference between patient and provider) rather than in‑person. - Pair…
22	Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…	- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
57	CPT® modifier -57 (“Decision for Surgery”) is appended to an Evaluation and Management (E/M) service when that encounter results in the initial decision to perform a major surgery (a procedure with a…	- Use modifier 57 when an E/M service provided by the same provider (or same tax ID) on the day of or the day before a major surgical procedure (90‑day global period) results in the initial decision…

Related Provider Taxonomies

8 rows

Taxonomy Code	Specialty	Notes
208000000X	Pediatrics Physician	A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectru…
207Q00000X	Family Medicine Physician	Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadt…
208D00000X	General Practice Physician	A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.
111NI0013X	Independent Medical Examiner Chiropractor	A special evaluator not involved with the medical care of the individual examinee that impartially evaluates the care being provided by other practiti…
174400000X	Specialist	An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond…
2085N0904X	Nuclear Radiology Physician	A radiologist who is involved in the analysis and imaging of radionuclides and radiolabeled substances in vitro and in vivo for diagnosis and the admi…
3336S0011X	Specialty Pharmacy	A pharmacy that dispenses generally low volume and high cost medicinal preparations to patients who are undergoing intensive therapies for illnesses t…
172P00000X	Naprapath	Naprapathy means a branch of medicine that focuses on the evaluation and treatment of neuron-muscular conditions. Doctors of naprapathy are connectiv…

Related ICD-10-CM Codes

24 rows

ICD-10-CM Code	Description
Z00.00	Encounter for general adult medical examination without abnormal findings
Z00.01	Encounter for general adult medical examination with abnormal findings
Z00.110	Health examination for newborn under 8 days old
Z00.111	Health examination for newborn 8 to 28 days old
Z00.121	Encounter for routine child health examination with abnormal findings
Z00.129	Encounter for routine child health examination without abnormal findings
Z00.2	Encounter for examination for period of rapid growth in childhood
Z00.3	Encounter for examination for adolescent development state
Z00.5	Encounter for examination of potential donor of organ and tissue
Z00.6	Encounter for examination for normal comparison and control in clinical research program

Showing 1–10 of 24

Related Payer Policy Updates

Specialty: Pediatrics/Neonatology1 / 2

10 rows

Policy	Payer	Effective Date
DRG Newborn Inpatient Stays - Facility	Blue Cross Blue Shield - Maine	2026-10-01
Pediatric Preventive Screening	Oscar Health	2026-10-01
Pediatric Preventive Screening	Blue Cross Blue Shield - New Mexico	2026-09-04
Pediatric Oral Function Therapy	Ambetter Georgia	2026-08-01
Prescribed Pediatric Extended Care (for Kentucky Only)	UnitedHealthcare	2026-08-01
Pediatric Preventive Screening	blue cross blue shield - louisiana	2026-08-01
Pediatric Oral Function Therapy	Health Net	2026-08-01
Pediatric Oral Function Therapy (Coverage Criteria)	Ambetter Nevada	2026-08-01
Pediatric Oral Function Therapy	Arizona Complete Health	2026-08-01
Pediatric Oral Function Therapy	Health Net	2026-08-01

CPT 98004: Established Patient Telemedicine E/M Visit, 10+ Minutes

CPT-98006-ESTABLISHED-PATIENT-AUDIO-VIDEO-EVALUATION-MANAGEMENT-30MIN

CPT 98006: Established Patient Telemedicine E/M, Moderate Complexity

CPT-98007-ESTABLISHED-PATIENT-TELEHEALTH-HIGH-COMPLEXITY-40-MIN

CPT 98007: Established Patient E/M via Synchronous Audio–Video, High MDM

Frequently Asked Questions

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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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 99392: Preventive Medicine Periodic Reevaluation, Pediatric/Adolescent

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National Reimbursement Benchmarks

OpenPayer

CPT 99392: Preventive Medicine Periodic Reevaluation, Pediatric/Adolescent

Sign up for cpt 99392 policy alerts

National Reimbursement Benchmarks

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Payer Policy Updates

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Payer Policy Updates

Related Codes

References

CPT 99392: Preventive Medicine Periodic Reevaluation, Pediatric/Adolescent

Sign up for cpt 99392 policy alerts

National Reimbursement Benchmarks

CPT 99392: Preventive Medicine Periodic Reevaluation, Pediatric/Adolescent

Sign up for cpt 99392 policy alerts

National Reimbursement Benchmarks

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Payer Policy Updates

Related Codes

What clinical services are described by CPT 99392?

Which modifiers should I consider when billing 99392 with additional services on the same day?

What are the national commercial reimbursement benchmarks for CPT 99392?

Where is 99392 typically performed and which specialties commonly bill it?

Can vision, hearing, or diagnostic tests be billed separately with 99392?

References

Clinical & Coding Specifications

Clinical Context

Related CPT Codes

Related Modifiers

Related Provider Taxonomies

Related ICD-10-CM Codes

Related Payer Policy Updates

Related Codes

What clinical services are described by CPT 99392?

Which modifiers should I consider when billing 99392 with additional services on the same day?

What are the national commercial reimbursement benchmarks for CPT 99392?

Where is 99392 typically performed and which specialties commonly bill it?

Can vision, hearing, or diagnostic tests be billed separately with 99392?

References