| Category | Amount |
|---|---|
| Medicare Allowed Rate What Medicare approves for this service | $82.62 |
| Typical Billed Amount What providers commonly charge | $125 – $300 |
| Potential Markup How much more you might pay vs. Medicare rate | 263% above Medicare |
What CPT Code 99391 Means for Your Baby's Care
CPT code 99391 represents a comprehensive preventive medicine visit for infants under one year old who are established patients. This means your baby has been seen by this healthcare provider before, and this is a follow-up well-child visit.
During a 99391 visit, your pediatrician will conduct a thorough physical examination, assess your baby's growth and development, discuss feeding and sleep patterns, provide age-appropriate vaccinations, and address any concerns you may have. These visits are crucial for monitoring your infant's healthy development and catching any potential issues early.
The visit typically includes measuring height, weight, and head circumference, checking reflexes and motor skills, examining eyes and ears, and reviewing developmental milestones. Your doctor will also discuss safety topics like car seat use, childproofing, and safe sleep practices.
Understanding the Costs and Billing for CPT 99391
When you receive a bill for CPT code 99391, you can expect to see charges typically ranging from $125 to $300, depending on your location and healthcare provider. The Medicare reimbursement rate for this service is $82.62, which gives you a baseline for what insurance companies consider reasonable.
On your bill or explanation of benefits, you'll see CPT 99391 listed along with the provider's charge. If your insurance covers preventive care (which most plans do under the Affordable Care Act), you may owe little to nothing out of pocket. However, if additional services were provided during the same visit, such as treatment for an illness, those may be billed separately and could result in additional costs.
Most insurance plans fully cover well-child visits as preventive care, but it's important to verify that your provider is in-network and that the visit is coded correctly as preventive rather than diagnostic care.
How to Verify Your CPT 99391 Bill is Correct
To ensure you're being billed correctly for CPT code 99391, first confirm that this was indeed a routine well-child visit for your baby under 1 year old, and that your child is an established patient with this provider. If this was your baby's first visit with this doctor, the correct code should be 99381 instead.
Check that the charge falls within the typical range of $125-$300. If you see a charge significantly higher than $300, contact your provider's billing department to ask for an explanation. Also verify that if your baby received vaccinations, those are billed separately with their own codes and not double-billed within the 99391 charge.
If you notice any errors or have questions about your bill, don't hesitate to call your healthcare provider's billing department. They can explain the charges and make corrections if necessary. You can also contact your insurance company to verify coverage and ensure claims were processed correctly for preventive care benefits.