CPT code 99391: Infant preventive visit, established patient2026 Medicare rate & RVUs

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

What 99391 covers

This code describes a routine preventive evaluation for an infant younger than one year who is an established patient. A pediatrician, family physician, or other qualified clinician typically provides the visit in an office or clinic. The service centers on age- and sex-appropriate history and examination, preventive counseling, anticipatory guidance, and risk-reduction discussions, rather than evaluation of a specific illness alone. An infant seen for a separate acute concern may also receive problem-oriented evaluation when that work is distinct from the preventive service.

Medicare classifies this CPT code as status N, meaning Medicare does not cover it. The code represents one preventive visit, not a timed service or a drug or supply unit. Use the established-patient age range to distinguish it from the infant preventive code for a new patient and from preventive visits for older children. For CPT purposes, an established patient has received professional services within the previous three years from the same physician or qualified health professional, or another physician or qualified health professional of the same specialty and subspecialty in the same group.

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 99391 pays more and less

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

109 of 109 payment localities

99391 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 99391 rate is calculated

Each of 99391’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 99391

99391 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.

99391 compared with similar codes

How to choose

99381Infant preventive visitNew patient, under 1 year

Both codes cover preventive care for an infant younger than one year. Choose 99391 for an established patient and 99381 for a new patient.

99392Well-child visitEstablished, age 1–4

Both are established-patient preventive visit codes, but 99391 is for infants younger than one year and 99392 is for children ages one through four.

99393Child preventive visitEstablished patient, age 5-11

Both are established-patient preventive visit codes, but 99391 is for infants younger than one year and 99393 is for children ages five through eleven.

Codes related to 99391

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