A Complete Guide to Pediatric CPT Codes in 2026

Effective January 1, 2026, the updated CPT code set includes changes that may affect pediatric billing, coding accuracy, and reimbursement. From immunizations and preventive visits to office visits and common pediatric procedures, some CPT codes remain the same while others are revised or updated. Hence, using the correct pediatric CPT codes is essential as it helps reduce denials, improve compliance, and prevent common medical billing errors such as upcoding and unbundling.

By listing the new, deleted, and updated pediatric CPT codes, we help practices choose the right ones, improving the clean claim rate. Let’s begin with what you should know to strengthen revenue cycle performance and boost cash flow.

Most Common Pediatric CPT Codes List (2026)

We have listed all pediatric billing codes, including commonly used pediatric CPT codes for 2026. It includes preventive visits, office visits, immunizations, screenings, and other common pediatric services. However, always remember that the final code selection depends on documentation, payer rules, and medical necessity.

CPT Code	Category	Patient Type	Age Group	Description
99381	Preventive / Well-Child Visit	New	Under 1 year	Initial preventive medicine visit for an infant
99382	Preventive / Well-Child Visit	New	1–4 years	Initial preventive medicine visit
99383	Preventive / Well-Child Visit	New	5–11 years	Initial preventive medicine visit
99384	Preventive / Well-Child Visit	New	12–17 years	Initial preventive medicine visit
99385	Preventive / Well-Child Visit	New	18–39 years	Initial preventive medicine visit
99391	Preventive / Well-Child Visit	Established	Under 1 year	Periodic preventive medicine reevaluation
99392	Preventive / Well-Child Visit	Established	1–4 years	Periodic preventive medicine reevaluation
99393	Preventive / Well-Child Visit	Established	5–11 years	Periodic preventive medicine reevaluation
99394	Preventive / Well-Child Visit	Established	12–17 years	Periodic preventive medicine reevaluation
99395	Preventive / Well-Child Visit	Established	18–39 years	Periodic preventive medicine reevaluation
99202	Office / Sick Visit	New	Any	Straightforward office visit
99203	Office / Sick Visit	New	Any	Low complexity office visit
99204	Office / Sick Visit	New	Any	Moderate complexity office visit
99205	Office / Sick Visit	New	Any	High complexity office visit
99211	Office / Sick Visit	Established	Any	Minimal problem visit
99212	Office / Sick Visit	Established	Any	Straightforward office visit
99213	Office / Sick Visit	Established	Any	Low complexity office visit
99214	Office / Sick Visit	Established	Any	Moderate complexity office visit
99215	Office / Sick Visit	Established	Any	High complexity office visit
90460	Immunization Administration	Any	Up to 18 years	First vaccine/toxoid component with counseling
90461	Immunization Administration	Any	Up to 18 years	Each additional vaccine/toxoid component
90471	Immunization Administration	Any	Any	First injected vaccine administration
90472	Immunization Administration	Any	Any	Each additional injected vaccine
90473	Immunization Administration	Any	Any	First oral/intranasal vaccine administration
90474	Immunization Administration	Any	Any	Each additional oral/intranasal vaccine
96110	Developmental Screening	Any	Any	Developmental screening with a standardized instrument
96127	Behavioral Screening	Any	Any	Brief emotional/behavioral assessment
99173	Vision Screening	Any	Any	Visual acuity screening
92551	Hearing Screening	Any	Any	Pure tone hearing screening
94640	Respiratory Treatment	Any	Any	Nebulizer/inhalation treatment
94760	Diagnostic Monitoring	Any	Any	Pulse oximetry
87880	Lab / Rapid Test	Any	Any	Rapid strep test
54150	Minor Procedure	Any	Infant	Circumcision using a clamp/device
69210	Minor Procedure	Any	Any	Ear wax removal when medically necessary
12001	Minor Procedure	Any	Any	Simple laceration repair (small wound)
10120	Minor Procedure	Any	Any	Foreign body removal, simple

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Pediatric CPT Codes for Well-Child Visits

Age groups categorize pediatric CPT codes for well-child visits into two categories: new patient and established. The well-child visits include annual check-ups that cover exams, developmental screening, and counseling.

New Patients (99381–99385)

The AMA introduced CPT codes for new patients, ranging from 99381–99385, indicating that these patients (infants, children, or adolescents) are receiving services for the first time.

Code	Description
99381	Under the age of 1 to evaluate the baby’s health, and guide parents for improvement (if needed).
99382	Children between the ages of 1 and 4 years.
99383	Children who are between 5 and 11 years old.
99384	Adolescent (aged 12 to 17).
99385	A young adult between the ages of 18 and 39.

Established Patients (99391–99395)

The AMA introduced CPT codes for established patients (99381–99385) who received preventive medical reevaluation and management services. It involves a physical and mental health assessment, history, and social history (PFSH) to make a thorough assessment of age- and gender-based risk factors. Moreover, the physician might order diagnostic/laboratory services and administer immunizations as part of preventive services.

Code	Description
99391	infant of < 1 year visits for preventive services.
99392	A child between 1 and 4 years old.
99393	A child between 5 and 11 years old.
99394	Adolescents aged 12 to 17.
99395	Young adult between 18 and 39.

Pediatric Evaluation & Management Codes

When pediatric specialists perform an evaluation and management service, whether in an office or during an outpatient visit, these services often involve parents of young children visiting for sick visits for ear infections, upper respiratory infections, or viral illnesses.

Here’s how to use these CPT codes for new and established patient visits.

CPT Code	Patient Type	Description
99202	New	Encounter a patient by spending 15 or more minutes on a straightforward medical decision.
99203	New	30 or more minutes to spend with the patient, for a low level of medical decision-making.
99204	New	45 or more minutes to spend with the patient, for a moderate level of medical decision-making.
99205	New	60 or more minutes for a high level of medical decision-making.
99211	Established	E/M services without the presence of any physician or qualified healthcare professional.
99212	Established	10 or more minutes of total time: straightforward medical decision-making.
99213	Established	20 or more minutes: low level of medical decision-making.
99214	Established	30 or more minutes: moderate level of medical decision-making.
99215	Established	40 or more minutes: high level of medical decision-making.

Pediatric Immunization Billing Codes Explained

When pediatricians provide counseling services to parents on immunizing their children with vaccines (not implemented yet) to prevent diseases. Parents will make the decision to vaccinate; however, it is essential to use CPT codes for pediatric immunization services. Here is how you should use these codes;

Code	Description
90482	Counseling for immunization lasts for 3 to 10 minutes.
90483	Counseling for immunization, but not administering the vaccine on the same day, lasts for 10 to 20 minutes.
90484	Use this code when the counseling lasts for more than 20 minutes.

Vaccine Administration (The "Act" of Injecting)

Use vaccine administration CPT codes when clinical staff or a physician administers a vaccine to a patient, based on the age.

Code	Description
90460	The provider administers the vaccine via parenteral, oral, intranasal, intramuscular, or intravenous routes to patients up to 18 years of age.
90461	An additional live vaccine for patients aged 18 years or older.
90471	The vaccine is injected into the patient via the percutaneous, intradermal, subcutaneous, or intramuscular route.
90472	Add-on code for each subsequent vaccine administration.

Pediatric Developmental & Behavioral Screening Codes

CPT Code 96110

Use 96110 when the provider uses a standardized instrument to screen for or diagnose a developmental disorder. It helps them focus on developmental milestones and age-appropriate speech and language maturity. By doing this, the provider can score and document the data, which helps improve patients’ developmental and behavioral health (if any).

CPT Code 96127

Use 96127 when the provider performs a brief emotional/behavioral assessment of the patient using a standardized instrument to score the data and document it.

Common Pediatric Coding Errors & How to Fix Them

Missing or Incorrect Modifier Usage

In pediatric medical billing and coding, the modifiers play an important role. Especially when you performed the preventive well-child check visit along with problem-oriented evaluation and management services on the same day, using modifier 25 is necessary to prevent claim rejections.

For example, if you see a patient for a preventive well-child visit check and the baby boy/girl needs an e/m service due to having pain in the ear, then you must use the 25 modifier to report a separate service.

Vaccine Administration and Product Errors

In pediatric billing and coding, vaccine administration (the labor and staff involved in injecting the product) and vaccine products (serum) must be billed under different CPT codes. Many pediatric clinics, hospitals, and organizations face most denials due to missing product codes or incorrect ones that don’t support the medical documentation.

For example, if a provider administers the DTaP-HepB-IPV vaccine (Pediarix), use CPT code 90723. For the first administration, use 90460; for subsequent vaccinations, use 90641 with the same product to get accurate payments.

Incorrect Age-Specific Preventive Codes

When it comes to the preventive well-child visit care, then age-specific CPT codes matter the most. Always ensure to use the accurate CPT codes, based on the age group (infant, early childhood, adolescent, adult).

If the CPT code for preventive care doesn’t match with the patient’s birthdate, then insurance company rejects the claim instantly.

Incorrect ICD-10 Diagnosis Codes

ICD-10 codes is as essential as using the CPT codes. If the diagnosis codes doesn;t match with the prodceudral ones, the denials occur.

For example; if you’re using CPT code 99393 then must use Z00.121 ICD-10 code for a timely, accurate reimbursements.

How Pediatricians Can Improve Coding Accuracy

Medical coding process isn’t as simple as we’ve thought, especially for pediatricians, due to the different age-group cpt codes, e/m ones with sickness visits modifiers necessity, and much more.

To overcome the coding challenges, many pediatrics now outsourcing medical billing and coding services to the expert RCM companies, who have specialization in pediatric billing services.

These medical billing companies help pediatricians improve reimbursements, prevent denials and reduce A/R days — optimizing overall revenue cycle process.

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Frequently Asked Questions

What makes pediatric billing different from other specialties?

Pediatric billing differs because it often includes age-based preventive visit coding, immunization administration, vaccine counseling, developmental screenings, growth monitoring, and frequent wellness visits. Pediatric claims also require careful coding for minors, parental counseling, and payer-specific vaccine coverage rules.

What are CPT codes 99213 and 99214 used for?

CPT codes 99213 and 99214 are commonly used for established patient office visits. Code 99213 is generally used for lower-complexity visits, while 99214 is used for moderate-complexity visits that require more evaluation, management, or physician time. Proper documentation is required to support the selected level.

What modifiers are commonly used in pediatric billing?

Common modifiers in pediatric billing may include:

Modifier 25 – Significant, separately identifiable E/M service on the same day as another procedure.
Modifier 59 – Distinct procedural service when appropriate.
Modifier 24 – Unrelated E/M service during postoperative period.
Modifier 95 – Telehealth services when accepted by payer.

Always verify payer-specific modifier guidelines.

What CPT codes are used for well-child visits?

Common preventive well-child visit CPT codes include:

99381–99385 for new patients.
99391–99395 for established patients.

These codes are generally selected based on patient age and visit type.

How often are CPT codes updated?

CPT codes are typically updated annually by the American Medical Association (AMA), with changes usually becoming effective on January 1 each year. Practices should review updates regularly to avoid outdated billing.

Can outsourced billing improve pediatric revenue?

Yes, outsourced pediatric billing can help improve revenue by reducing coding errors, accelerating claim submission, improving denial follow-up, and increasing collection efficiency. It can also reduce administrative workload for in-house staff.

What is a taxonomy code in pediatric billing?

A taxonomy code is a provider classification code used on claims to identify the provider’s specialty and type. In pediatric billing, it helps payers recognize that services were performed by a pediatrician or pediatric specialty provider.

How can pediatricians reduce coding denials?

Pediatricians can reduce denials by:

Using correct CPT and ICD-10 codes.
Verifying insurance eligibility before visits.
Maintaining complete documentation.
Applying modifiers correctly.
Reviewing payer policy changes.
Performing routine billing audits.
Submitting clean claims promptly.

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