CPT code 99393: Child preventive visit, established patient, age 5-112026 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 99393 covers

This code represents a routine, comprehensive preventive visit for a child age 5 through 11 who is an established patient. Pediatricians, family physicians, and other clinicians providing preventive care may report it for a well-child appointment. The visit can include an age-appropriate history and examination, developmental and behavioral assessment, anticipatory guidance, risk-reduction counseling, and planning for preventive services such as immunizations or screening tests.

Medicare assigns this CPT Category I code physician fee schedule status N, meaning Medicare does not cover it. Select it for an established patient in this age range; the new-patient preventive code for the same ages is 99383, while established-patient codes 99392 and 99394 cover younger and older age bands. A separately evaluated illness or injury may support an additional problem-oriented E/M service when its requirements are met; document that work separately.

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 99393 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

99393 rates by state

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

How the 99393 rate is calculated

Each of 99393’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 99393

99393 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.

99393 compared with similar codes

How to choose

99383Child preventive visitNew patient, age 5–11

Both codes cover preventive visits for ages 5 through 11. Choose 99383 for a new patient and 99393 for an established patient.

99392Well-child visitEstablished, age 1–4

99392 is for established-patient preventive visits in the younger age band; 99393 is for ages 5 through 11.

99394Adolescent preventive visitEstablished, ages 12–17

99394 is for established-patient preventive visits in the older age band, beginning at age 12; 99393 covers ages 5 through 11.

99213Office visitEstablished patient, low complexity

99213 is a problem-oriented office or outpatient E/M service for an established patient, not a periodic comprehensive preventive visit.

Codes related to 99393

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