2025 CPT code 99393
(Active) Effective Date: N/A Revision Date: N/A Preventive Medicine - Established Patient Evaluation and Management > Preventive Medicine Services Feed
Periodic comprehensive preventive medicine reevaluation and management for an established patient aged 5-11 years, including age and gender-appropriate history, exam, counseling, and ordering of labs/diagnostic tests.
Modifier 25 may be appended to code 99393 if a significant, separately identifiable E/M service is provided on the same day.
Preventive medicine services are considered medically necessary to detect potential health problems early and promote overall well-being.Regular check-ups are crucial for children's health and development.
The physician performs a comprehensive age- and gender-appropriate history, physical examination, counseling, anticipatory guidance and risk factor reduction interventions, and orders any necessary lab tests and immunizations.
- Evaluation and Management > Preventive Medicine Services
- Evaluation and Management > Preventive Medicine Services > Established Patient
In simple words: This code covers a routine checkup for an established child patient between 5 and 11 years old.The doctor will talk with the child and parents, do a physical exam, give advice on health and safety, and may order tests.Vaccines and other tests are billed separately.
This CPT code, 99393, reports a preventive medicine reevaluation and management service for an established patient aged 5-11 years.The service includes a comprehensive history and examination appropriate for the child's age and gender, along with counseling and anticipatory guidance for risk factor reduction.The ordering of appropriate immunizations, laboratory, and/or diagnostic procedures is also included.Separate reporting is required for the administration of vaccines/immunizations,vaccine risk/benefit counseling, and any ancillary studies (e.g., vision, hearing, developmental screenings).
Example 1: A 7-year-old established patient presents for a routine annual check-up. The physician performs a complete history, physical examination, including assessment of growth and development, assesses for any concerns related to school and social interactions, counsels the parent regarding age-appropriate safety issues, and administers recommended immunizations.Laboratory testing for Hemoglobin and a Urinalysis are ordered., A 10-year-old established patient presents for an annual wellness visit.The physician reviews the child's medical records, assesses for any developmental concerns, performs a comprehensive physical exam, addresses the parent's questions about puberty, and provides anticipatory guidance related to nutrition and lifestyle habits.Vision and Hearing screenings are performed., A 6-year-old established patient presents for a well-child visit. The physician conducts a complete history, physical examination, and addresses the parents' concerns about the child's recent behavioral changes.Following the preventive visit, the physician determines further evaluation is needed and conducts a separate problem-focused E/M visit which is billed with modifier 25. This additional visit addresses the child's behavioral concerns and involves detailed history, mental status exam and orders additional testing.
Complete medical history, physical examination documentation, documentation of counseling/anticipatory guidance provided, documentation of any ordered laboratory or diagnostic tests, and documentation of administered immunizations.For separate problem-focused E/M services, detailed documentation of the problem, assessment, and plan is necessary.
** Always refer to the most current CPT codebook and payer guidelines for accurate coding and reimbursement.
- Revenue Code: M1B (Office Visits - Established)
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Fee Schedule: Historical fee schedules vary by payer and location. Check historical fee schedules for your specific payer.
- Specialties:Pediatrics, Family Medicine
- Place of Service:Office