Most Common Pediatric CPT Codes

In pediatric healthcare, proper billing is crucial for ensuring accurate reimbursement and maintaining efficient operations. Using the correct CPT codes for services provided not only ensures that providers are reimbursed appropriately but also helps with compliance and tracking care delivery. 

Understanding the most commonly used pediatric CPT codes, such as those for well-child visits, immunizations, and screenings, is essential for pediatricians and medical billers to stay organized and accurate.

What Are CPT Codes?

CPT codes, or Current Procedural Terminology codes, are used to describe medical, surgical, and diagnostic procedures and services. These codes are essential for billing, ensuring that healthcare providers are paid for the services they offer. 

In pediatrics, specific CPT codes are assigned for well-child visits, vaccinations, developmental screenings, and other common services, allowing for clear documentation and proper reimbursement from insurers.

Most Common Pediatric CPT Codes

Pediatric CPT codes are essential for accurate billing and ensuring that services like routine check-ups, immunizations, and screenings are properly documented. Below are some of the most commonly used pediatric CPT codes.

CPT 99381-99385 & 99391-99395 – Well-Child Visits

These CPT codes are used for well-child visits, where a pediatrician performs a routine examination of a child’s health, development, and growth.

• CPT 99381-99385 are for new patients, with the numbers reflecting the child’s age (for example, 99381 is used for a new patient aged 0-1 years, while 99385 is used for a new patient aged 11-17 years).
• CPT 99391-99395 are for established patients (those who have previously seen the pediatrician). These codes are used to document annual check-ups that focus on preventative care, health screenings, and updates on immunizations.

CPT 90460-90461 – Immunization Administration with Counseling

These codes are used for the administration of vaccines along with counseling services provided to the patient or the caregiver. CPT 90460 is for the administration of a single vaccine with counseling, while CPT 90461 applies when multiple vaccines are given during the same visit. 

Pediatricians commonly use these codes during well-child visits when immunizations are updated. In fact, the Centers for Disease Control and Prevention (CDC) reports that vaccines prevent over 4 million deaths worldwide each year, highlighting the critical role immunizations play in ensuring the health and safety of children.

CPT 96110 – Developmental Screening

This code is used when a pediatrician performs a developmental screening during a well-child visit, such as screening for autism or developmental delays. 

These screenings are essential for identifying potential developmental concerns early, allowing for prompt intervention and support.

CPT 92552 – Pure Tone Audiometry

Often included in pediatric health assessments, this code is used when a hearing screening is performed, typically around ages 4-5. 

Routine hearing screenings are part of the standard well-child check-up and are vital for identifying early signs of hearing loss or other auditory issues.

CPT 99213 – Office Visit for Established Patients

This code is used for office visits that are not related to a routine well-child check-up but are instead for follow-up visits or treatment of minor, non-complex issues. 

It’s frequently used for established patients who need care for non-acute conditions, such as minor illnesses or concerns that arise between well-child visits.

CPT 99406 – Smoking Cessation Counseling

If relevant, pediatricians may use this code to bill for counseling services related to smoking cessation, particularly for older children or adolescents. 

This is an essential service for preventing long-term health risks and addressing habits that can affect the child’s future health.

According to the CDC, nearly 9 out of 10 smokers start before the age of 18, making early intervention and counseling critical in preventing long-term tobacco addiction and related health issues.

Why These CPT Codes Matter in Pediatrics?

These CPT codes are critical for documenting and billing the essential services pediatricians provide. They help ensure that children receive appropriate preventive care and that healthcare providers are reimbursed for their services. 

Well-child visits, immunizations, and screenings are all necessary components of pediatric care that help prevent future health issues and promote healthy development. Using these specific codes ensures that pediatric practices stay compliant with insurance requirements while offering high-quality care.

Conclusion

Understanding and correctly applying CPT codes in pediatrics ensures accurate billing and reimbursement in pediatric healthcare. These codes are vital for documenting preventive care, including immunizations, screenings, and routine check-ups that promote children’s health.

By staying informed and adhering to best practices in billing and documentation, pediatric practices can enhance their operations, minimize errors, and guarantee accurate reimbursement. If your practice needs expert pediatrics billing services, our team is ready to provide tailored, seamless billing solutions to meet your needs.