Pediatric CPT Codes for 2024 + Modifiers

Failure to maintain accurate and current codes in your pediatric practice could result in missed revenue opportunities through medical billing. Moreover, inaccuracies could lead to delays in claims processing, underscoring the necessity of staying informed about the latest code updates.

Pediatric CPT Code Ranges for 2024

Here are the 2024 pediatric CPT codes:

• 99381 – New patient, preventative care for infant; < 1 year of age
• 99382 – New patient, preventative care; 1-4 years old
• 99383 – New patient, preventative care; 5-11 years old
• 99384 – New patient, preventative care; 12-17 years old
• 99385 – New patient, preventative care; 18+ years old
• 99391 – Established, patient preventative care for infant
• 99392 – Established, preventative care for 1-4 years old
• 99393 – Established, preventative care for 5-11 years old
• 99394 – Established, preventative care for 12-17 years old
• 99395 – Established, preventative care for 18+ years old
• 99401 – 15-minute counseling; preventative medicine or risk reduction, individual
• 99402 – 30-minute counseling; preventative medicine or risk reduction, individual
• 99403 – 45-minute counseling; preventative medicine or risk reduction, individual
• 99404 – 60-minute counseling; preventative medicine or risk reduction, individual
• 99411 – 30-minute counseling; preventative medicine or risk reduction, group
• 99411 – 60-minute counseling for preventative medicine or risk reduction, group
• 99211 – Office visit that doesn’t require a qualified health professional
• 99491 – Chronic care management, first 30 minutes
• 99437 – Chronic care management, each additional 30 minutes
• 99487 – Complex chronic care management, first 30 minutes
• 99489 – Complex chronic care management, each additional 30 minutes
• 99424 – Principal care management for a high-risk disease, by the primary care provider or chronic care specialist, first 30 minutes
• 99425 – Principal care management for a high-risk disease, by the primary care provider or chronic care specialist, each additional 30 minutes
• 99426 – Principal care management for a high-risk disease, carried out by clinical staff under the guidance of a qualified health professional, first 30 minutes
• 99427 – Principal care management for a high-risk disease, carried out by clinical staff under the guidance of a qualified health professional, each additional 30 minutes

Seasonal RSV Monoclonal Antibody Immunization Codes

Here are the new seasonal RSV monoclonal antibody immunization pediatric codes for children (less than 24 months):

• 90380 – Respiratory syncytial virus, monoclonal antibody, seasonal dose; for intramuscular use, 0.5 mL dosage
• 90381 – Respiratory syncytial virus, monoclonal antibody, seasonal dose; for intramuscular use; 1 mL dosage
• 96380 – Administration of respiratory syncytial virus, monoclonal antibody, seasonal dose by intramuscular injection; with counseling by physician or other qualified health care professional.
• 96381 – Administration of respiratory syncytial virus, monoclonal antibody, seasonal dose by intramuscular injection

Pediatric CPT Modifiers

You can use the following 2024 pediatric CPT modifiers to make a code more specific:

• Z00.110 – newborn under 8 days old health supervision
• Z00.111 – newborn between 8 and 28 days old health supervision
• Z00.121 – routine health exam for a child with abnormal findings
• Z00.129 – routine health exam for a child with no abnormal findings
• Z00.00 – routine health exam for an adult with no abnormal findings
• Z00.01 – routine health exam for an adult with abnormal findings
• Z28.3 – under-immunized status
• Z71.3 – dietary counseling or surveillance
• Z71.82 – exercise counseling
• Z71.84 – health counseling for travel purposes
• Z71.85 – counseling for immunization safety
• Z71.89 – other counseling, specified
• Z71.9 – other counseling, unspecified

For informational purposes only.