CPT Code Lookup Tool

Use this free CPT Lookup Tool to search for Current Procedural Terminology (CPT) codes, descriptions, and related details — designed to help streamline and simplify your medical billing process.

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99213

Office or other outpatient visit

Evaluation and management of an established patient...

Evaluation & Management Active RVU:
Important: This tool uses AI to assist with code lookups. While we strive for accuracy, AI can make mistakes. Always verify information with official coding resources before using in medical billing or clinical documentation.
S
CPT Code Status
Current Status: Active
Last Updated: January 1, 2023
Implementation Date: January 1, 1992

Information

This code is for use in medical billing and coding.

C
CPT Code Details
Code: 99213
Code Type: Category I
Code Format: 5-digit numeric

Information

This code is part of the section of CPT codes.

D
CPT Code Description

Office or other outpatient visit for the evaluation and management...

Note

This description reflects the 2021 E/M coding guidelines.

CA
Category & Classification
Category: Evaluation & Management
Subcategory: Office or Other Outpatient Services
Code Range: 99202-99215

Information

codes are used to report evaluation and management services provided in various settings.

RV
Relative Value Units
Total RVU: 2.46
Work RVU
1.30
Practice Expense
0.96
Malpractice
0.20

Information

RVUs are used to determine the fee for a service under the Medicare Physician Fee Schedule.

MS
Medical Specialties
Common Specialties:
No specialty information available.

Information

This code is commonly used by primary care providers, but may be used by any specialty providing office visits.

M
Commonly Used Modifiers
Modifiers:
No modifier information available.

Information

Modifiers provide additional information about the service provided.

Detail About CPT 99391

Related CPT Codes

CPT CodeDescription
99392 Periodic comprehensive preventive medicine reevaluation and management of an individual (1-4 years)
99393 Periodic comprehensive preventive medicine reevaluation and management of an individual (5-11 years)
99394 Periodic comprehensive preventive medicine reevaluation and management of an individual (12-17 years)
99395 Periodic comprehensive preventive medicine reevaluation and management of an individual (18-39 years)
99396 Periodic comprehensive preventive medicine reevaluation and management of an individual (40-64 years)

Commonly Billed With

  • CPT 99392 - Periodic comprehensive preventive medicine reevaluation and management (1-4 years)

    Often billed together for continued preventive care across different age groups.

  • CPT 36415 - Routine venipuncture

    Commonly performed in conjunction with preventive care visits for lab work.

Clinical Scenarios

Scenario 1

A 6-month-old infant comes in for a routine well-child visit, including vaccinations and developmental screening.

Scenario 2

A 9-year-old child presents for a yearly physical exam, growth assessment, and counseling on healthy lifestyle habits.

Scenario 3

A 16-year-old adolescent visits for a sports physical, discussion on risk behaviors, and mental health screening.

Scenario 4

A 35-year-old patient schedules a preventive care appointment for chronic disease risk assessment and personalized health goals.

Frequently Asked Questions

Q1: When should I use CPT 99391?

CPT 99391 is used for the periodic comprehensive preventive medicine reevaluation and management of an individual under 1 year of age.


Q2: What documentation is required for CPT 99391?

Documentation should include age-appropriate history, examination, counseling, anticipatory guidance, and risk factor reduction interventions.


Q3: What are common modifiers used with CPT 99391?

Commonly used modifiers include 25 for significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure, and 59 for distinct procedural service.


i clas = "fas fa-question me - 2" > Q4: What are common denial reasons for CPT 99391?

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p clas = "mb - 0 ps - 4" > Shortage of appropriate documentation supporting the medical necessity of the service or incorrect coding/billing information can lead to denials for CPT 99391. / p >

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i clas = "fas fa-question me - 2" > Q5: How does CPT 99391 differ from similar codes?

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p clas = "mb - 0 ps - 4" > CPT code 99391 specifically applies to patients under 1 year of age, while related codes like CPT 99392 to CPT 99396 cover different age ranges for periodic comprehensive preventive care. / p >

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