2025 CPT code 99392
(Active) Effective Date: N/A Revision Date: N/A Preventive Medicine - Established Patient; Early Childhood (age 1 through 4 years) Evaluation and Management > Preventive Medicine Services Feed
This CPT code represents a comprehensive preventive medicine visit for an established patient aged 1-4 years.It includes a history, exam, counseling, and ordering of labs/procedures.
Modifier 25 may be appended if significant, separately identifiable E/M services are provided on the same day.Modifier 33 may be used to indicate that the service was a preventive service.
Medical necessity for preventive medicine services is generally established by the patient's age and the guidelines recommended by professional organizations for well-child care.The service is considered medically necessary to identify and mitigate potential health risks during the critical developmental years.
The physician's responsibility includes conducting a comprehensive history, physical exam, age/gender-appropriate counseling, and ordering necessary tests. The physician assesses risk factors and provides anticipatory guidance.
- Evaluation and Management > Preventive Medicine Services
- Preventive Medicine Services; Established Patient; Ages 1-4 years
In simple words: This code is for a well-child checkup for a child between 1 and 4 years old who is already a patient at the doctor's office. The doctor will talk to you, examine your child, give you advice on keeping your child healthy, and may order tests.
CPT code 99392 reports a periodic, comprehensive preventive medicine reevaluation and management service for an established patient aged 1 through 4 years. The service encompasses an age- and gender-appropriate history, examination, counseling, anticipatory guidance, risk factor reduction interventions, and the ordering of appropriate laboratory/diagnostic procedures.Immunizations administered during this visit are billed separately.If a significant problem arises requiring additional work beyond the preventive service, codes 99202-99215 with modifier 25 should also be reported.
Example 1: A 2-year-old established patient comes for a routine well-child visit.The physician performs a complete physical exam, reviews developmental milestones, provides anticipatory guidance on nutrition and safety, and administers recommended immunizations.All are documented in the chart., A 3-year-old established patient presents for a well-child check. During the exam, the physician notes a concerning heart murmur.This finding leads to additional assessment and referral to cardiology. In this case, 99392 would be billed for the preventive visit, along with an appropriate E/M code for the cardiology consult,using modifier 25., A 4-year-old established patient is brought in for a wellness visit; during the visit the physician determines that the patient needs a referral to an ophthalmologist for vision testing because the child is demonstrating squinting behavior.99392 would be coded along with any referrals and other appropriate tests and procedures.
* Comprehensive history including presenting problem, past medical history, family history, social history, and review of systems.* Complete physical examination appropriate for the age and gender.* Documentation of counseling/anticipatory guidance/risk factor reduction interventions.* Documentation of any ordered laboratory or diagnostic procedures.* Documentation of immunizations administered (if any).
** This code should only be used for established patients.New patients should be billed using code 99382.
- Revenue Code: M1B (Office Visits - Established)
- RVU: RVUs vary based on geographic location and other factors.Consult your local payer's fee schedule.
- Global Days: This code does not have a global period.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Fee Schedule: Historical fee schedule data varies by payer and location. Consult historical fee schedules from relevant payers.
- Specialties:Pediatrics, Family Medicine
- Place of Service:Office