Well Child Care Visit Code for 11-Year-Old New Patient
For a comprehensive well child care visit for an 11-year-old new patient, use CPT code 99384. 1
CPT Code Selection
The appropriate billing code is 99384, which falls within the preventive care visit code range (99381-99394) specifically designated for pediatric preventive care visits. 1
Age-Specific Code Range
- CPT codes 99381-99394 are designated for pediatric preventive care visits and include the EPSDT (Early and Periodic Screening, Diagnostic and Treatment) program. 1
- Code 99384 specifically covers comprehensive preventive medicine evaluation and management for new patients aged 5-11 years. 1
New vs. Established Patient Distinction
- Since this is a new patient, you must use the 99381-99387 series (not the 99391-99397 series for established patients). 1
- The "new patient" designation applies when the patient has not received professional services from the physician or another physician of the same specialty in the same group practice within the past 3 years. 1
Additional Coding Considerations
Developmental Screening Add-On Codes
If developmental or behavioral screening is performed during the visit, you can bill additional codes:
- CPT 96110: Developmental screening (does not include physician work; clinical staff administers and scores). 1
- CPT 96111: Extended developmental testing (typically up to 1 hour by the medical provider). 1
- These codes are reported in addition to the preventive care E/M code with modifier 25 appended to the preventive care code. 1
When Additional E/M Codes May Apply
If significant problem-oriented evaluation occurs during the well child visit that is separate and distinct from the preventive care service:
- You may bill an additional office visit code (99201-99205 for new patients) with modifier 25 appended to indicate a separately identifiable service. 1
- This is appropriate only when substantial additional physician work addresses acute or chronic problems beyond routine preventive care. 1
Common Pitfalls to Avoid
- Do not confuse the age ranges: 99384 is for ages 5-11 years; 99385 would be for ages 12-17 years. 1
- Do not use office visit codes (99201-99215) for routine well child care—these are for problem-focused visits. 1
- Do not bill developmental screening codes (96110) as standalone services without the preventive care visit code. 1
- Ensure proper documentation of all components of the comprehensive preventive visit including history, examination, anticipatory guidance, and risk assessment. 2