CPT 99393: Established Well-Patient Visit for Child Age 5–11
Commercial payers pay $105 on average nationally for this procedure.
CPT code 99393 describes a periodic comprehensive preventive medicine visit for an established child aged 5 through 11, encompassing an age-appropriate history, physical examination, anticipatory guidance, counseling, and ordering of routine screening or diagnostic services as indicated; service type: established well-child preventive visit; typical site of service: outpatient clinic or pediatric/primary care office.
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 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.