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.
Other relevant CPT codes
- 99383: Preventive visit, new patient, late childhood age 5 through 11
- 99391: Preventive visit, established patient, under 1 year
- 99392: Preventive visit, established patient, ages 1–4
- 99394: Preventive visit, established patient, ages 12–17
Frequently asked questions
Yes, if a significant problem is evaluated—bill the E/M code with modifier 25 and document separately.
No. It is based on the components of preventive care, not time spent.
No. Immunizations and their administration must be reported separately.
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