CPT 99391: Preventive Visit, Established Patient, Infant
Periodic comprehensive preventive medicine reevaluation and management of an established patient, infant under age 1.
Why CPT 99391 Claims Get Denied
Claims billed under CPT 99391 are frequently denied or downcoded for the following reasons. Understanding these patterns helps your practice reduce denial rates and recover revenue faster.
Too many well-child visits within the EPSDT schedule
Bundled with same-day immunization administration
Missing preventive diagnosis code
Documentation does not support comprehensive exam
Billing Tips for CPT 99391
Follow the AAP Bright Futures schedule for well-child visit frequency. Bill immunizations separately. Medicaid/EPSDT programs have specific periodicity schedules that allow more frequent visits than commercial plans.
Documentation Requirements
To support a clean claim for CPT 99391, your clinical documentation should include:
Age-appropriate history update
Complete physical examination
Growth chart documentation
Developmental milestone assessment
Immunization administration
Parental counseling and anticipatory guidance
Common Modifiers for CPT 99391
Reduce CPT 99391 Denials by 60%
RediClaim's pre-submission scrubber catches documentation gaps and coding errors before you submit, while the appeal generator handles denials that slip through.