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CPT 99393: Established Well-Child Visit, Ages 5–11
CPT code 99393 represents the periodic comprehensive preventive medicine reevaluation and management visit for an established child aged 5 through 11 years. As a routine well-child visit code, it documents age-appropriate history, physical examination, counseling/anticipatory guidance, and ordering of any needed screening or diagnostic procedures. This code matters nationally because preventive pediatric visits are a primary avenue for immunizations, developmental surveillance, counseling on nutrition and activity, and school/sports clearance, influencing health outcomes and utilization patterns across payers.
Key payers included in this overview are Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare. Readers will find a concise summary of the clinical definition and service setting for 99393, comparisons to adjacent pediatric preventive codes for other age groups, and practical coding context relevant to billing and administrative workflows. The content highlights typical indications for use (routine health exams, school or sports evaluations when conducted as part of a preventive visit) and notes common diagnosis mappings used to support the service.
The publication provides national-level context useful for billing managers, clinicians, and policy analysts seeking clear documentation of service content, payer coverage scope, and related coding relationships. Data not available in the input is noted where applicable.
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Billing Code Overview
CPT code 99393 describes a periodic comprehensive preventive medicine reevaluation and management visit for an established pediatric patient aged 5 through 11 years. The service includes an age-appropriate history, physical examination, counseling, anticipatory guidance, risk-factor reduction interventions, and ordering of age-appropriate laboratory or diagnostic procedures.
Service Type: Established well-child preventive visit
Typical Site of Service: Outpatient office or clinic (pediatric or primary care setting)
National Reimbursement Benchmarks
Commercial rates for CPT 99393 center on BUCA’s average commercial benchmark of $104.90, with notable variation among national carriers. Blue Cross Blue Shield shows a relatively tight middle distribution (P75–P25 = $40.50), while Aetna and Cigna exhibit wider spreads (Aetna P75–P25 = $89.40; Cigna P75–P25 = $77.90). UnitedHealth Group displays the largest spread (P75–P25 = $79.70), indicating broader negotiated variability across regions or plan types.
Mean reimbursements cluster above BUCA for UnitedHealth Group ($142.10) and Cigna ($125.50), while Blue Cross Blue Shield’s mean ($86.60) sits below BUCA. Aetna’s mean is $120.30 and BUCA’s mean remains $104.90, positioning BUCA as a mid-market commercial average amid payers with both tighter and wider dispersion profiles.