CPT code 99383: Child preventive visit, new patient, age 5–112026 Medicare rate & RVUs in Massachusetts

CMS doesn’t publish an office rate for 99383 in Massachusetts.

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

What 99383 covers

For a child ages 5 through 11, this service is a comprehensive preventive evaluation rather than a visit focused on a new illness or injury. The clinician obtains age-appropriate health and developmental history, performs a preventive examination, and provides anticipatory guidance and counseling on health promotion and risk reduction. Pediatricians, family physicians, and other qualified clinicians commonly report it in primary care settings. Preventive planning can include ordering appropriate screening tests or immunizations; separately performed services may be coded under their applicable codes.

The Medicare Physician Fee Schedule assigns status N, meaning this service is not covered by Medicare. Select it only when the child meets CPT’s new-patient definition: no professional service from the same physician, or another physician of the same specialty and subspecialty in the same group, within the prior three years. A child returning to the same physician or to a physician of the same specialty and subspecialty in the same group within that interval is generally reported with the established-patient age-specific preventive code, 99393.

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 99383 pays more and less in Massachusetts

How the 99383 rate is calculated

Each of 99383’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 99383

99383 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.

99383 compared with similar codes

How to choose

99393Child preventive visitEstablished patient, age 5-11

Both codes cover preventive visits for ages 5–11. Choose 99393 when the child is established under CPT’s three-year new-patient definition.

99382Preventive visitNew patient, age 1-4

This is the new-patient preventive code for ages 1–4; 99383 applies to ages 5–11.

99384Adolescent preventive visitNew patient, ages 12–17

This is the new-patient preventive code for ages 12–17; 99383 applies to ages 5–11.

Codes related to 99383

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