CPT® code 99393 is used to report a periodic comprehensive preventive medicine evaluation and management (E/M) visit for an established patient aged 5 through 11 years. This service is typically provided in pediatric, family medicine, and integrative wellness clinics.
What is CPT Code 99393?
CPT 99393 covers a routine well-child visit for school-aged children. The service includes a thorough history and physical examination, along with age-appropriate screening, counseling, and anticipatory guidance. It is designed to monitor and promote a child’s growth, development, and overall health.
Key components of this visit often include:
- Assessment of physical growth and developmental milestones
- Evaluation of immunization status and administration of vaccines as needed
- Screening for vision, hearing, and behavioral issues
- Counseling parents and children on nutrition, safety, physical activity, and emotional well-being
- Review of family and social history affecting the child’s health
This visit focuses on prevention and health maintenance, rather than addressing acute or chronic illnesses.
When to Use CPT Code 99393
Use CPT 99393 for periodic preventive visits in established pediatric patients aged 5 to 11 years. These visits are typically scheduled annually or according to recommended well-child visit guidelines.
Documentation should include:
- Comprehensive developmental and behavioral assessments
- Review of growth charts and vital signs
- Immunization records and any administered vaccines
- Preventive counseling and anticipatory guidance topics
- Any screening tests performed and results
Coding Considerations
- CPT 99393 applies only to preventive services for established patients; use CPT 99382 for new patients in this age group.
- Time is not the primary factor for billing; instead, the comprehensiveness of the evaluation and counseling drives the code selection.
- If the visit includes evaluation and management of a separate illness or injury, report those services with appropriate E/M codes in addition to 99393.
- Use proper ICD-10 Z codes to indicate preventive care and counseling (e.g., Z00.129 for general pediatric examination).
CPT 99393 and Pediatric Preventive Care
Regular preventive visits help identify potential health concerns early, promote healthy habits, and support families in managing their child’s health. Payers generally cover these services under routine well-child visit benefits.
Successful billing requires documentation that demonstrates the comprehensive nature of the exam, the age-specific counseling provided, and any screenings or immunizations performed during the visit.
Simplify Pediatric Wellness Visits with OptiMantra
For pediatric and family medicine practices, managing detailed documentation, immunization tracking, and age-specific preventive requirements can be complex. OptiMantra streamlines this process by offering:
- Customizable templates for documenting wellness visits, including pediatric-specific needs
- Automated growth charts
- Easy generation of CPT-coded superbills that align with ICD-10 preventive codes
- Seamless submission of claims to insurance payers with built-in eligibility checks
With OptiMantra, clinicians can efficiently deliver thorough, compliant preventive care—helping children thrive while ensuring your practice maximizes reimbursement.
Try OptiMantra for free here!
