CPT code 99381: Infant preventive visit, new patient, under 1 year2026 Medicare rate & RVUs in Texas

CMS doesn’t publish an office rate for 99381 in Texas.

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 99381 covers

99381 reports a comprehensive preventive evaluation and management visit for a new infant patient younger than 1 year. The clinician obtains an age-appropriate health history, performs a preventive examination, and provides counseling or anticipatory guidance to the caregiver. Pediatricians and other clinicians provide this service in settings such as an office or clinic as part of routine well-child care.

CMS physician fee schedule status N identifies 99381 as not covered by Medicare. Select it for a new-patient preventive service in the infant age band; an established infant uses 99391, while a new patient aged 1 through 4 years uses 99382. This code identifies a preventive encounter, not a problem-focused visit for an acute illness.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where 99381 pays more and less in Texas

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

8 of 8 payment localities

How the 99381 rate is calculated

Each of 99381’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

Payment rules and modifiers for 99381

99381 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.

99381 compared with similar codes

How to choose

99391Infant preventive visitEstablished patient

Choose 99391 for a preventive visit when the infant is an established patient; 99381 is for a new patient.

99382Preventive visitNew patient, age 1-4

Choose 99382 for a new patient aged 1 through 4 years; 99381 is for an infant younger than 1 year.

99383Child preventive visitNew patient, age 5–11

99383 is for a new patient aged 5 through 11 years, rather than an infant younger than 1 year.

Codes related to 99381

Related codes aren’t interchangeable: bill the code that matches the service performed.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates