2025 CPT code 99381
(Active) Effective Date: N/A Revision Date: N/A Preventive Medicine - Preventive Medicine Services Evaluation and Management Feed
Initial comprehensive preventive medicine evaluation and management for a new infant patient (under 1 year).
Modifier 25 may be used with codes 99202-99215 if a separate, significant E&M service is provided on the same day. Modifier 33 (Preventive Services) is also appropriate for this code.
Preventive care is medically necessary for the early detection and prevention of disease and health problems in infants.Regular well-baby visits allow for timely interventions and improved health outcomes.
The physician performs a comprehensive assessment of the infant's health, including a thorough history, physical exam, and anticipatory guidance. They also order necessary tests and discuss preventive health measures with the parents or guardians.
In simple words: This code covers a complete well-baby checkup for a baby less than one year old who is seeing this doctor for the first time.It includes a physical exam, talking with the parents about health, safety and growth, and ordering tests as needed.Shots are billed separately.
This CPT code, 99381, represents an initial comprehensive preventive medicine evaluation and management service for a new patient who is an infant less than one year old.The service includes an age- and gender-appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of any appropriate laboratory/diagnostic procedures.Immunizations are reported separately.If a significant, separately identifiable problem is addressed, an additional office/outpatient E&M code (99202-99215) with modifier 25 may be reported.
Example 1: A new patient, a 6-month-old infant, presents for their first well-baby visit.The physician performs a complete physical exam, assesses developmental milestones, and counsels the parents on nutrition, sleep, and safety.The physician also orders a CBC and urinalysis.Code 99381 is used., A 9-month-old infant, a new patient, is brought in for a well-child check-up. The physician conducts a detailed history, performs a comprehensive physical exam, and administers age-appropriate immunizations (billed separately).The parents express concerns about the baby's sleep patterns, prompting further discussion and guidance. Code 99381 is reported along with the separate immunization codes., An 11-month-old infant, new patient, is brought in for a well-baby check. During the exam, the physician detects a heart murmur.Because this is a significant finding, the physician performs additional tests and detailed assessments.Code 99381 is reported along with an appropriate office/outpatient E&M code (e.g., 99202-99215) with modifier 25.
Detailed documentation should include a complete history (including prenatal and birth history, family history, immunization records), a thorough physical examination, and documentation of counseling/anticipatory guidance provided to the parents/guardians.Records of any ordered tests and results should also be included.
** This code is used only for new patients.Established patient visits are coded differently (e.g., 99391 for infants).
- Revenue Code: M1A (Office Visits - New)
- RVU: The RVUs for this code vary based on the geographic location and other factors. Consult the CMS Physician Fee Schedule for the current values.
- Global Days: Not applicable. This is a preventive medicine service, not a surgical procedure.
- Payment Status: Active
- Modifier TC rule: Not applicable.This is not a procedure with a technical component.
- Fee Schedule: Fee schedules vary by year and payer.Consult historical fee schedules from relevant payers for specific historical data.
- Specialties:Pediatrics, Family Medicine
- Place of Service:Office, Outpatient