Well-Care Frequency Chart (preventive medicine CPT codes)
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Governs frequency/payability guidance for well-care / periodic comprehensive preventive medicine CPT codes and who can bill them under Central California Alliance for Health.
No material clinical or coverage changes in this revision.
Well-Care Coverage Criteria
Well-care coverage criteria (chart entries)
Payability guidance for listed well-care (periodic comprehensive preventive medicine) CPT codes as shown in the Well-Care Frequency Chart:
CPT Codes and Frequency Details
| 99381 | New patient periodic comprehensive preventive medicine |
| 99391 | Periodic comprehensive preventive medicine 0-12 months (infant/toddler age bands) |
| 99393 | Periodic comprehensive preventive medicine 3-4 years / 5-11 years |
| 99394 | Periodic comprehensive preventive medicine 5-11 years / 12-17 years |
| 99395 | Periodic comprehensive preventive medicine 12-17 years / 18-39 years |
| 99385 | Established patient periodic comprehensive preventive medicine |
Billing and Provider Guidance
Well‑care CPT frequency billing rules
Follow the payable frequencies listed in the Well-Care Frequency Chart when billing periodic comprehensive preventive medicine (well‑care) CPT codes. Bill each code only at the frequency shown for that code/age band — e.g., 99381 (new patient) once every 36 months; 99391 entries include a payable every 14 days notation for one pediatric band; 99393 and 99394 are shown payable once per 180 days; 99395 is shown payable once every 12 months.
- 99381 — New patient periodic comprehensive preventive medicine: Once every 36 months.
- 99391 — Periodic comprehensive preventive medicine (0–12, 12–23, 24–35 months bands): chart includes at least one entry with “payable every 14 days.”
- 99393 — Periodic comprehensive preventive medicine (3–4 years; 5–11 years): payable once per 180 days.
- 99394 — Periodic comprehensive preventive medicine (5–11 years; 12–17 years): payable once per 180 days.
- 99395 — Periodic comprehensive preventive medicine (12–17 years; 18–39 years): payable once every 12 months.
Key Definitions
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