CPT Code 99393: Preventive Medicine, Established Patient, Ages 5–11

Familiarize yourself with the documentation requirements and billing guidelines of CPT code 99393 for accurate coding and proper reimbursement.

Use Code

What is the 99393 CPT code?

CPT code 99393 represents a "periodic comprehensive preventive medicine evaluation and management service for an established patient, late childhood age 5 through 11."

The comprehensive preventive medicine services referred to include the following:

An age and gender appropriate history
Physical examination
Anticipatory guidance
Risk factor reduction interventions and counseling
Health maintenance recommendations

It is typically rendered during annual wellness or school physicals and may include immunization review, developmental surveillance, and behavioral risk assessments.

Do note that 99393 excludes evaluation and management of new or existing medical problems—those should be coded separately if addressed in detail during the same encounter.

CPT code 99393 documentation requirements

Following CPT coding guidelines for 99393, the documentation of said code must include:

Age and gender appropriate comprehensive history (development, family, behavioral, school performance)
Comprehensive physical exam elements: growth chart, BMI, vision, hearing, vitals
Immunization status
Counseling and anticipatory guidance
Screening tests (e.g., lead, anemia, cholesterol, behavioral)

Separate documentation is needed for significant problems managed during the visit (report with modifier 25 on E/M service if applicable).

CPT code 99393 billing guidelines

Maintaining compliance in healthcare for accurate reimbursement for CPT code 99393. To do so, one must follow the billing guidelines for the aforementioned code below:

Must reflect the patient is established (seen by the practice in the last 3 years).
Do not report with problem-oriented E/M unless significant additional work was done and separately documented.
Confirm payer-specific policies regarding preventive care coverage and coding.