| Category | Amount |
|---|---|
| Medicare Allowed Rate What Medicare approves for this service | $90.47 |
| Typical Billed Amount What providers commonly charge | $135 – $325 |
| Potential Markup How much more you might pay vs. Medicare rate | 259% above Medicare |
What CPT 99393 Means for Your Child's Care
When you take your child for their annual well-check or physical exam, your doctor will likely use CPT code 99393 if your child is between 5 and 11 years old. This code covers a comprehensive preventive medicine visit that includes a thorough physical examination, reviewing your child's growth and development, updating vaccinations, and discussing any health concerns.
During these visits, your pediatrician will check your child's height, weight, vision, hearing, and overall development. They'll also review your child's medical history, discuss nutrition and safety, and provide age-appropriate health education. This is different from a sick visit - it's specifically for preventive care when your child is healthy.
The visit typically lasts 20-30 minutes and is an important part of keeping your child healthy as they grow. Most insurance plans, including Medicaid, cover these preventive visits as they're considered essential healthcare.
What to Expect on Your Medical Bill
When you receive your bill or explanation of benefits (EOB), you'll see CPT code 99393 listed for your child's well-check visit. The Medicare rate for this service is $90.47, though most pediatric practices don't accept Medicare since it primarily covers adults over 65.
For most families, the typical charge range is $135 to $325, depending on your location and healthcare provider. If you have insurance, you'll likely see the original charge, any insurance adjustments, what your insurance paid, and what you owe (if anything). Many insurance plans cover preventive visits at 100%, meaning you may not owe anything out of pocket.
If additional services were provided during the visit - like vaccines, lab tests, or treatment for a specific concern - these will appear as separate line items with different CPT codes on your bill.
How to Verify Your Billing is Correct
To check if you were billed correctly, first confirm that your child was between 5-11 years old at the time of the visit and that it was indeed a well-check appointment, not a sick visit. If your child was younger than 5, the correct code should be 99383, and if they were 12 or older, it should be 99394.
Compare the charges on your bill to the typical range of $135-$325. If the charge seems unusually high (over $325), contact your healthcare provider's billing department to ask for an itemized explanation. Sometimes additional services are bundled in that should be listed separately.
If you believe there's an error, don't hesitate to call the billing office. Common issues include using the wrong age-based code or billing for additional services that weren't actually provided. Keep notes from your conversation and ask for any corrections to be made in writing. If you're still not satisfied, you can contact your insurance company or your state's insurance commissioner for help resolving billing disputes.