CPT code 99383: Preventive medicine, new patient, ages 5–11

Gain insight on how to properly use CPT code 99383 with our guide that comes with information on the code's documentation and billing requirements.

Use Code

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)