Pediatric CPT Codes
Pediatric billing revolves around the well-child schedule and the vaccines that come with it. The preventive codes ladder by age, vaccine administration has its own counseling-based codes that count components rather than shots, and screening tools bolt on with their own codes. The recurring theme: a single well visit generates five to ten claim lines, and the money is in not dropping any of them.
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Pediatrics CPT codes
Well-Child Visit, Established, Age 1–4
Early-childhood preventive visit. The 99391–99395 family ladders by age.
Well-Child Visit, Established, Age 5–11
School-age preventive visit including age-appropriate screening and counseling.
Well-Child Visit, New Patient, Age 12–17
Adolescent new-patient preventive visit.
Vaccine Administration with Counseling, First Component
Administration of the first vaccine component with physician counseling, through age 18.
Vaccine Administration, Each Additional Component (Add-on)
Each additional component in the same or combination vaccine.
Developmental Screening, Per Instrument
Standardized developmental screen, scored and documented. Billed per instrument.
Codes in blue have full detail pages with documentation requirements, billing mistakes, and FAQ.
Pediatrics billing notes
Well-child codes split by age and status: 99381–99385 for new patients from infancy to adolescence, 99391–99395 established. The age bands change the code automatically as the child grows.
Vaccine administration with counseling (90460 plus 90461 per additional component) counts vaccine components, not injections. A combination vaccine with three components is one 90460 and two 90461, provided face-to-face counseling is documented.
The vaccine products bill separately from administration. Practices in the Vaccines for Children program bill administration only for VFC-supplied doses.
Developmental screening (96110) bills alongside the well visit when a standardized instrument is used and scored. It's per instrument, so two screens can mean two units.
A sick concern addressed during a well visit bills as a separate E&M with modifier 25 when it's significant and separately documented. Parents should hear about the possible second charge before checkout.
Frequently asked questions about pediatrics billing
How do I bill vaccine administration for a combination vaccine?▼
By components, not by shots. One injection of a three-component combination vaccine with documented counseling bills 90460 for the first component and 90461 twice for the others. Without counseling, or for patients over 18, the count switches to the 90471 series, which counts injections instead.
Can I bill a sick visit during a well-child check?▼
Yes, when the problem is significant enough to stand alone, like an ear infection found during the exam. Bill the preventive code plus the E&M with modifier 25 and separate documentation for the problem. Small incidental findings folded into normal well-visit counseling don't justify the second code.
Is developmental screening included in the well visit?▼
No. 96110 bills separately each time a standardized instrument like the ASQ or M-CHAT is administered and scored, even on the same day as the preventive visit. It's per instrument, and most payers cover it at the ages recommended by Bright Futures.
Sources
- Code set structure and updates: American Medical Association — CPT
- Fee schedule and component billing rules: CMS Medicare Physician Fee Schedule
- How we research and verify: our editorial policy
CPT® is a registered trademark of the American Medical Association. Content on this page is original educational writing, not a reproduction of AMA-copyrighted descriptions. Verify codes and payer rules before billing.