What is the 99383 CPT code?
CPT code 99383 represents an "initial comprehensive preventive medicine evaluation and management service provided to a new patient aged 5 through 11 years."
These preventive medicine services include a comprehensive health assessment, examination, counseling, and anticipatory guidance, risk factor reduction interventions, age-appropriate screenings, and ordering of laboratory and diagnostic procedures.
Do note that this code is not for established patients but new patients who have not received care from the provider or group in the last three years.
CPT code 99383 documentation requirements
To support the billing for CPT code 99383, the key components present in the medical record are the following:
- Comprehensive history, more specifically, an age and gender-appropriate history
- An age and gender-appropriate physical examination, including growth and developmental milestones
- Anticipatory guidance and health risk counseling
- Ordering of laboratory/diagnostic procedures/screening tests or assessments: vision, hearing, anemia, behavioral, and other reasons for ordering them
- Review of immunization status and vaccine planning
If a significant issue is identified and addressed, document separately for E/M coding with modifier 25. Furthermore, it is recommended that the healthcare provider use the appropriate Z-codes for the preventive service and the specific diagnosis codes for any condition discovered when documenting.
CPT code 99383 billing guidelines
To ensure proper reimbursement, one must follow the recommended billing guidelines for CPT code 99383 below:
- Use only for new patients aged 5-11
- Use the proper "Z-codes" or diagnosis codes when reporting
- Not time-based; determined by the extent of preventive services delivered.
- Can be reported with vaccine administration, lab tests, and vision screening.
- Ascertained if the code will be covered by the federal insurance program or by the commercial insurance carrier of the patient
- Reviewed the specific billing guidelines of the FQHCs
Other relevant CPT codes
- 99381: Preventive visit, new patient under 1
- 99382: Preventive medicine, new patient; early childhood (age 1 through 4 years)
- 99384: Preventive medicine, new patient; adolescent (age 12 through 17 years)
Frequently asked questions
The patient had no face-to-face service by the physician or the same specialty group in the past 3 years.
Yes. Vision screening can be billed separately if performed and documented.
No. Order and bill tests like hemoglobin, lead, or urinalysis separately.
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