CPT® code 99383 is used to report an initial comprehensive preventive medicine evaluation and management (E/M) visit for a new patient aged 5 through 11 years. This service is typically performed in pediatric, family medicine, and integrative wellness clinics.
What is CPT Code 99383?
CPT 99383 represents the first preventive visit where a new pediatric patient aged 5 to 11 years receives a thorough history, physical examination, and anticipatory guidance. This evaluation is designed to promote healthy development, assess growth, and provide tailored counseling for school-age children.
This visit commonly includes:
- A detailed review of medical, family, and social history
- Measurement and assessment of growth parameters such as height, weight, and BMI
- Screening for vision, hearing, behavioral, and developmental concerns
- Evaluation of immunization status and administration if needed
- Counseling on nutrition, physical activity, safety, and emotional health
- Guidance tailored to the child’s school environment and lifestyle
The goal is to establish a comprehensive baseline for ongoing health maintenance and preventive care.
When to Use CPT Code 99383
Use CPT 99383 for new patients aged 5 to 11 years presenting for their initial preventive medicine visit. This code should not be used for problem-focused or acute care visits.
Documentation should include:
- A comprehensive history covering medical, developmental, and social factors
- Complete physical examination findings appropriate to the age group
- Immunization records and administration details
- Counseling and education topics discussed with the child and caregivers
- Screening results for any identified risks or concerns
Coding Considerations
- CPT 99383 is reserved for new patients; use CPT 99393 for established patients in this age range.
- Time is not the primary factor; the focus is on the completeness of the preventive service.
- If evaluation and management for an illness or injury occur during the visit, these services should be reported separately with appropriate E/M codes.
- Use relevant ICD-10 Z codes indicating preventive care (e.g., Z00.129 for general pediatric examination).
CPT 99383 and School-Aged Child Preventive Care
Initial preventive visits for school-aged children are essential for identifying potential health issues early, reinforcing healthy behaviors, and addressing developmental and psychosocial needs. Insurers generally provide coverage under routine well-child benefits.
Effective documentation supports the medical necessity of preventive counseling, screening, and immunizations.
Streamline Pediatric Preventive Care with OptiMantra
Managing the complexity of comprehensive pediatric preventive visits can be challenging. OptiMantra offers tailored solutions for pediatric and family practices, including:
- Customizable templates for school-aged well visit
- Documentation prompts for comprehensive history, exam, and counseling
- Integration of CPT and ICD-10 coding to reduce errors and denials
- Simplified insurance claim submission and patient follow-up management
OptiMantra helps clinicians provide thorough, compliant preventive care—supporting healthier kids and smoother reimbursements for your practice.
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