Summary & Overview
CPT 99392: Preventive Medicine Reevaluation for Early Childhood, Established Patient
CPT code 99392 represents a comprehensive preventive medicine reevaluation and management service for established pediatric patients aged 1 through 4 years. This code is nationally significant as it supports routine child health examinations, which are critical for early detection of health issues, developmental monitoring, and providing families with anticipatory guidance and risk factor reduction strategies. The service is typically delivered in an office setting and is a cornerstone of pediatric and family medicine practices.
Major payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare. The publication provides an overview of payer coverage, policy updates, and clinical context for the use of 99392. Readers will gain insights into billing benchmarks, relevant modifiers, associated taxonomies, and common ICD-10 diagnoses linked to this preventive service. The article also highlights related CPT codes for vision and hearing screening, as well as office visits when both well and sick visits are reported.
This summary equips healthcare professionals, billing specialists, and policy analysts with a clear understanding of the clinical and administrative aspects of 99392, supporting informed decision-making in preventive pediatric care.
CPT Code Overview
CPT code 99392 is used for periodic comprehensive preventive medicine reevaluation and management of an established patient in early childhood, specifically ages 1 through 4 years. This service includes an age and gender appropriate history, examination, counseling, anticipatory guidance, risk factor reduction interventions, and the ordering of laboratory or diagnostic procedures. The typical site of service for this code is the office setting (Place of Service 11). These preventive medicine services are essential for monitoring child health, development, and providing guidance to families during early childhood.
Clinical & Coding Specifications
Clinical Context
A 2-year-old child, established with the practice, presents to the office for a routine early childhood preventive medicine visit. The provider conducts a comprehensive age-appropriate history and physical examination, offers counseling and anticipatory guidance to the parent regarding nutrition, safety, and developmental milestones, and orders recommended laboratory or diagnostic tests as indicated. The visit is focused on preventive care and does not address acute illness. If a separate, significant issue is addressed during the same encounter, an additional evaluation and management service may be reported with modifier 25.
Coding Specifications
- Modifier
25: Used when a significant, separately identifiable evaluation and management (E/M) service is performed by the same physician on the same day as the preventive medicine service. For example, if the child is seen for a preventive visit and also evaluated for an acute illness, modifier25is appended to the sick visit code.
| Provider Taxonomy Code | Specialty |
|---|---|
208000000X | Pediatrics |
207Q00000X | Family Medicine |
208D00000X | General Practice |
Related Diagnoses
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Z00.129: Encounter for routine child health examination without abnormal findings- Used when the preventive visit reveals no abnormal findings.
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Z00.121: Encounter for routine child health examination with abnormal findings- Used when the preventive visit identifies abnormal findings requiring further evaluation.
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Z02.5: Encounter for examination for participation in sport- Used when the visit is for clearance to participate in sports activities.
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Z02.0: Encounter for examination for admission to educational institution- Used when the visit is for school entry or admission requirements.
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Z02.89: Encounter for other administrative examinations- Used for preventive visits required for other administrative purposes, such as camp or daycare.
Related CPT Codes
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99212–99215: Office or other outpatient established patient visits. These codes are used when both a preventive (well) and a sick visit occur on the same day, with modifier25applied to the sick visit code. -
99173: Vision screen. This code is reported separately from the preventive medicine service if vision screening is performed during the visit. -
92551: Hearing screen. This code is reported separately from the preventive medicine service if hearing screening is performed during the visit.
Clinical Workflow Relation:
99212–99215are commonly used in conjunction with99392when an acute issue is addressed during the preventive visit.99173and92551may be performed as part of the preventive visit but are billed separately if vision or hearing screening is provided.
National Reimbursement Benchmarks
National mean rates for CPT code 99392 show that UnitedHealth Group has the highest average reimbursement at $143.44, while Aetna is the lowest among the major commercial payers at $107.79. The BUCA (average commercial) mean rate is $115.50, which is notably higher than typical Medicare rates for similar services, though Medicare-specific data is not available in the input.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies across payers. Blue Cross Blue Shield has a relatively tight range ($52.00), while Cigna exhibits the widest spread ($78.75), indicating greater variability in negotiated rates. UnitedHealth Group also shows a substantial range ($79.00), suggesting significant rate differences across providers.
The table and chart below present the full breakdown of national benchmarks for each payer, including mean rates and percentile values.
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