CPT 99383: Preventive visit, new patient, age 5-11
What this code means, what it should cost, and how to dispute an overcharge.
Fair Price Reference
What is CPT 99383?
CPT 99383 (Preventive visit, new patient, age 5-11) is a preventive billing code defined by the American Medical Association. It's used to bill your insurance or you directly for this service.
What CPT 99383 should cost
The Centers for Medicare & Medicaid Services (CMS) pays approximately $97 for CPT 99383 under the 2025 Physician Fee Schedule. This is what the federal government has determined is a reasonable payment for this service.
Private insurance typically pays 1.2–1.8x Medicare rates ($116–$175). Hospital chargemaster prices for CPT 99383 often range from $160 to $450 — a markup of 1.6x to 4.6x over Medicare.
Common overcharges on CPT 99383
The most common issue is 'double-billing' — a provider bills the preventive visit (99385–99397) AND a separate sick visit E&M code (99213–99215) for the same appointment. While this is sometimes legitimate (Modifier 25), many providers routinely add the office visit charge for addressing any minor question during the physical, even when it doesn't meet the threshold of a 'significant, separately identifiable' problem.
About Preventive billing
Preventive visit codes (annual physicals, well-child visits, wellness exams) cover a comprehensive head-to-toe evaluation at defined age intervals. Under the ACA, many preventive services must be covered at 100% with no cost-sharing when performed by an in-network provider — but billing errors can turn a free annual physical into a surprise bill.
Request visit notes. If the provider billed both a preventive code and an office visit code, the documentation must show a distinct, significant clinical problem addressed beyond the scope of the preventive visit. If the provider simply discussed an existing condition, refilled medications, or answered routine questions, the separate E&M charge is not justified.
How to dispute a CPT 99383 overcharge
- Request the itemized bill. You are entitled to a detailed line-by-line bill showing every CPT code billed. Ask in writing.
- Compare to Medicare allowable. If the charge exceeds 150% of Medicare ($146), you have grounds to dispute.
- Request documentation. For E&M codes, ask for the visit note. For procedures, ask for the operative report. The documentation must justify the code billed.
- Send a formal dispute letter. Cite the specific discrepancy between the documentation and the code. Reference Medicare rates and NCCI edits where applicable.
- Follow up in writing. Give the provider 30 days to respond. If they don't, escalate to the state attorney general and insurance commissioner.
Got CPT 99383 on your bill?
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