CODING FOR

Pediatric
Preventive
Care 2025
 Coding for Pediatric Preventive Care, 2025
Following are the Current Procedural Terminology (CPT®), Healthcare
Common Procedure Coding System (HCPCS) Level II, and
International Classification of Diseases, 10th Revision, Clinical Modification
(ICD-10-CM) codes often reported by pediatricians in providing
preventive care services.

SYMBOL DESCRIPTION

• A bullet at the beginning of a code means it is a new code for the current year.
+ A plus sign means the code is an add-on code.
A lightning bolt indicates that a vaccine product code was approved by
CPT, but the vaccine product is still pending FDA approval.

The recommendations in this publication do not indicate an exclusive course of

treatment or serve as a standard of medical care. Variations, taking into account
individual circumstances, may be appropriate.
© 2025 American Academy of Pediatrics
All rights reserved. No part of this publication may be reproduced, stored in a retrieval
system, or transmitted in any form or by any means—electronic, mechanical,
photocopying, recording, or otherwise—without prior written permission from the
publisher.
Current Procedural Terminology (CPT®) 5-digit codes, nomenclature, and other data are
copyright 2025 American Medical Association (AMA). All rights reserved. No fee schedules,
basic units, relative values, or related listings are included in CPT. The AMA assumes no
liability for the
data contained herein.
The Bright Futures/American Academy of Pediatrics “Recommendations for Preventive
Pediatric Health Care,” also known as the “periodicity schedule,” is a schedule of screenings
and assessments recommended at each well-child visit from infancy through adolescence. The
following services
and codes coincide with this schedule. For more details on the periodicity schedule, see
[Link]
schedule/.

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 PREVENTIVE MEDICINE SERVICE CODES
Services included under these codes include measurements (eg,
length/ height, head circumference, weight, body mass index, blood
pressure) and age- and gender-appropriate examination and history
(initial or interval).
Preventive medicine service codes are not time-based; therefore,
time spent during the visit is not relevant in selecting the
appropriate preventive medicine service code.
If an illness or abnormality is discovered, or a preexisting
problem is addressed, in the process of performing the
preventive medicine service, and if the illness, abnormality, or
problem is significant enough to require additional work to perform
the components of a problem-oriented evaluation and
management (E/M) service (ie, using medical decision making
or time spent), the appropriate office or other outpatient service
code (99202–99215) should be reported in addition to the
preventive medicine service code. Append modifier 25 to the
office or other outpatient service code (eg, 99392 and 99213 25).
An insignificant or trivial illness, abnormality, or problem encountered
in the process of performing the preventive medicine service should
not be separately reported.
Immunization products and administration and ancillary studies
involving laboratory, radiology, or other procedures, or screening
tests (eg, vision, developmental, hearing) identified with a specific
CPT code, are reported separately from the preventive medicine
service code.

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Preventive Medicine Services: New Patients
Initial comprehensive preventive medicine E/M of an individual
includes an age- and gender-appropriate history; physical
examination; counseling, anticipatory guidance, or risk factor
reduction interventions; and the ordering of laboratory or diagnostic
procedures.
A new patient is defined as one who has not received any
professional face-to-face services rendered by physicians and other
qualified health care professionals (QHPs) who may report E/M
services and reported by a specific CPT code(s) from a
physician/other QHP, or another physician/other QHP of the exact
same specialty and subspecialty who belongs to the same group
practice, within the past 3 years.

CPT Codes ICD-10-CM Codes

99381 Infant (younger than 1 Z00.110 Health supervision for
year) newborn under 8 days
old or
Z00.111 Health supervision for
newborn 8 to 28 days
old or
Z00.121 Routine child health
exam
with abnormal findings or
Z00.129 Routine child health
exam
without abnormal findings
99382 Early childhood (age 1–4 Z00.121 Routine child health
years) exam
with abnormal findings or
99383 Late childhood (age 5–11 Z00.129 Routine child health
years) exam
without abnormal findings
99384 Adolescent (age 12–17
years)
99385 18 years or older Z00.00 General adult medical
exam
without abnormal findings
Z00.01 General adult medical
exam
with abnormal findings

3
Preventive Medicine Services: Established Patients
Periodic comprehensive preventive medicine reevaluation and
management of an individual includes an age- and gender-
appropriate history; physical examination; counseling, anticipatory
guidance, or risk factor reduction interventions; and the ordering of
laboratory or diagnostic procedures.

CPT Codes ICD-10-CM Codes

99391 Infant (younger than 1 year) Z00.110 Health supervision for
newborn under 8 days old
or
Z00.111 Health supervision for
newborn 8 to 28 days old or
Z00.121 Routine child health exam
with abnormal findings or
Z00.129 Routine child health exam
without abnormal findings
99392 Early childhood (age 1–4 years) Z00.121 Routine child health exam
with abnormal findings or
99393 Late childhood (age 5–11 years)
Z00.129 Routine child health exam
99394 Adolescent (age 12–17 years) without abnormal findings
99395 18 years or older Z00.00 General adult medical exam
without abnormal findings
Z00.01 General adult medical exam
with abnormal findings

Preventive Medicine Services: With And Without Abnormal

Findings The use of an ICD-10-CM code for with abnormal findings (eg,
Z00.121) does not mean that an additional E/M service must or can be
used.
Abnormal findings can be trivial or incidental issues that do not
require additional work, but the condition is still documented or
listed as con- tributory. Examples of abnormal findings include
abnormal screening results, new acute problem, or unstable or
worsening chronic condition.
A stable chronic condition (whether addressed or not) would not
warrant the use of an abnormal findings code. You can link an
abnormal findings ICD-10-CM code to a screening if the screen is
normal; the abnormality will be identified with the appropriate ICD-10-
CM code so the payer will be aware.

4
 COUNSELING, RISK FACTOR REDUCTION, AND
BEHAVIOR CHANGE INTERVENTION

Used to report services provided for the purpose of promoting

health and preventing illness or injury.
They are distinct from other E/M services that may be reported
separately when performed. However, one exception is you
cannot report counseling codes (99401–99404) in addition to
preventive medicine service codes (99381–99385 and 99391–
99395).
Counseling will vary with age and address such issues as
family dynamics, diet and exercise, sexual practices, injury
prevention, dental health, and diagnostic or laboratory test
results available at the time of the encounter.
Codes are time-based, where the appropriate code is selected
according to the approximate time spent providing the
service. Codes may be reported when the midpoint for that
time has passed. For example, once 8 minutes are
documented, one may report 99401.
Extent of counseling or risk factor reduction intervention
must be documented in the patient chart to qualify the
service based on time.
Counseling or interventions are used for persons without a
specific illness for which the counseling might otherwise be used
as part of treatment.
Cannot be reported with patients who have symptoms or
established illness.
For counseling individual patients with symptoms or
established illness, report an office or other outpatient service
code (99202– 99215) instead.
For counseling groups of patients with symptoms or
established illness, report 99078 (physician educational
services rendered to patients in a group setting) instead.

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Preventive Medicine, Counseling
CPT Codes
99401 Preventive medicine counseling or risk factor reduction
intervention(s) provided to an individual; approximately 15
minutes
99402 approximately 30 minutes
99403 approximately 45 minutes
99404 approximately 60 minutes
99411 Preventive medicine counseling or risk factor reduction
intervention(s) provided to individuals in a group setting;
approximately 30 minutes
99412 approximately 60 minutes

ICD-10-CM Codes for Preventive Counseling

The diagnosis codes reported for preventive counseling will vary depending
on the reason for the encounter.
Remember that the patient cannot have symptoms or established illness;
therefore, the diagnosis codes reported cannot reflect symptoms or illnesses.
Examples of some possible diagnosis code ranges include:
Z28.3-Under immunized status (Code also reason patient is behind, Z28.8-
[Immunization not carried out for other reason])

Z71.3 Dietary counseling and surveillance

Z71.82 Exercise counseling

Z71.84 Encounter for health counseling related to travel

Z71.85 Encounter for immunization safety counseling (Code

also if the vaccine is not carried out [eg, Z28.82])
Z71.9 counseling, unspecified

Behavior Change Interventions, Individual

Used only when counseling a patient (not parent) on smoking
cessation (99406, 99407).
If counseling a patient’s parent or guardian on smoking cessation, do not
report these codes (99406, 99407) under the patient; instead, refer

6
 to preventive medicine counseling codes (99401–99404) if the patient is not
currently experiencing adverse effects (eg, illness), or include under the
problem-related E/M service if patient is present for a
sick visit (99202–99215).
Codes 99406–99409 may be reported in addition to the preventive
medicine service codes.

CPT Codes
99406 Smoking and tobacco use cessation counseling visit;
intermediate, greater than 3 minutes up to 10 minutes
99407 intensive, greater than 10 minutes
99408 Alcohol or substance (other than tobacco) abuse structured
screening (eg, Alcohol Use Disorder Identification Test [AUDIT],
Drug Abuse Screening Test [DAST]) and brief intervention (SBI)
services; 15 to 30 minutes
99409 greater than 30 minutes

ICD-10-CM Codes for Risk Factor Reduction and Behavior

Change Interventions
F10.1- Alcohol abuse
F11.1- Opioid abuse
F12.1- Cannabis abuse
F13.1- Sedative, hypnotic, or anxiolytic abuse
F15.9- Other stimulant use, unspecified
F16.9- Hallucinogen use, unspecified
F17.29- Nicotine dependence, other tobacco products (Includes
Electronic nicotine delivery systems [ENDS]/vaping
products)
Z71.4- Alcohol abuse counseling and surveillance
Z71.5- Drug abuse counseling and surveillance
Z71.6 Tobacco abuse counseling
Z87.891 Personal history of nicotine dependence
Z91.89 Other specified personal risk factors, not elsewhere classified

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 OTHER PREVENTIVE MEDICINE SERVICES
Oral Health
CPT Code
99188 Application of topical fluoride varnish by a physician or
other qualified health care professional (QHP)

ICD-10-CM Codes

Z00.121 Routine child health exam with abnormal findings

Z00.129 Routine child health exam without abnormal findings
Z29.3 Encounter for prophylactic fluoride administration
Z91.841 Risk for dental caries, low
Z91.842 Risk for dental caries, moderate
Z91.843 Risk for dental caries, high
Z91.849 Unspecified risk for dental caries

Pelvic Examination
Preventive medicine service codes (99381–99385 and 99391–99395)
include a pelvic examination as part of the age- and gender-
appropriate examination.
If the patient is having a problem, the physician can report an
office or other outpatient E/M service code (99212–99215) for the
visit and attach modifier 25, which identifies that the problem-
oriented pelvic visit is a separately identifiable E/M service by the
same physician on the same date of service.
Link the appropriate ICD-10-CM code for the well-child or well-
adult examination with abnormal findings (Z00.121 or Z00.01) to
the preventive medicine service code, but link a different diagnosis
code (eg, N89.8 [vaginal discharge], N94.4 [primary dysmenorrhea])
to the office or other outpatient E/M service code (eg, 99212).
Anticipatory or periodic contraceptive management is not a
“problem” and is therefore included in the preventive medicine
service code; however, if contraception creates a problem (eg,
breakthrough bleeding, vomiting), the service can be reported
separately with
an office or other outpatient service code.

8
ICD-10-CM
Codes

Z01.411 Gynecological exam with abnormal findings

Z01.419 Gynecological exam without abnormal findings
Z11.51 Screening for human papillomavirus (HPV)
Z12.72 Screening for malignant neoplasm of vagina
Z30.011 Initial prescription of contraceptive pills
Z30.012 Prescription of emergency contraception
Z30.013 Initial prescription of injectable contraceptive
Z30.014 Initial prescription of intrauterine contraceptive device (IUD)
Z30.015 Encounter for initial prescription of vaginal ring hormonal
contraceptive
Z30.016 Encounter for initial prescription of transdermal patch hormonal
contraceptive device
Z30.017 Encounter for initial prescription of implantable subdermal
contraceptive
Z30.018 Encounter for initial prescription of other contraceptives
Z30.02 Counseling and instruction in natural family planning to avoid
pregnancy
Z30.09 General counseling and advice on
Z30.40 Contraception Surveillance of contraceptives,
Z30.41 Unspecified Surveillance of contraceptive pills
Z30.42 Surveillance of injectable
Z30.430 Contraceptive Insertion of IUD
Z30.431 Routine checking of
Z30.432 IUD Removal of IUD
Z30.4313 Removal and reinsertion of IUD
Z30.434 Encounter for surveillance of vaginal ring hormonal
contraceptive device
Z30.45 Encounter for surveillance of transdermal patch hormonal contraceptive
device
Z30.46 Encounter for surveillance of implantable subdermal contraceptive
Z30.49 Surveillance of other contraceptives

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Health Risk Assessments
CPT Codes
96160 Administration of patient-focused health risk assessment
instrument (eg, health hazard appraisal) with scoring and
documentation, per standardized instrument
96161 Administration of caregiver-focused health risk assessment in-
strument (eg, depression inventory) for the benefit of the patient,
with scoring and documentation, per standardized instrument

NOTE: Code 96161 can be reported for a postpartum screening

administered to a mother as part of a routine newborn check but billed
under the baby’s name. Link to ICD-10-CM code Z00.121 or Z00.129 for
normal screening results during a routine well-baby examination. Do not
report ICD-10-CM code Z13.31 or Z13.32 under the baby, as those are only
for the maternal record. Alternatively, payers may require G0442 (Annual
alcohol misuse screening, 15 minutes) in lieu of 96160 if screening for
alcohol use.
Used to report the administration of standardized health risk assessment
instruments on the patient (96160) or a primary caregiver (e.g., parent) on
behalf of the patient (96161). Code 96160 would be used to report a
standardized suicide risk assessment linked to ICD-10-CM code Z13.39
(Encounter for screening examination for other mental health and behavioral
disorders).
Code 96161 requires that the questions and answers relate to the primary
caregiver’s health and behaviors, not the patient’s. For standardized ques-
tionnaires about the family's environment (that includes the patient), report
code 96160.
CPT defines standardization as “Standardized instruments are validated tests
that are administered and scored in a consistent or ‘standard’ manner
consistent with their validation.”
A non-standardized screen or assessment is not separately reported unless a
specific payer allows.
Unlisted Preventive Medicine Service
CPT Code
99429 Unlisted preventive medicine service
Report code 99429 only when a more specific preventive medicine service
code does not exist.

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 SCREENING CODES

Developmental/Autism Screening and

Behavioral/Social/ Emotional Screening
CPT Codes ICD-10-CM Codes
96110 Developmental Z13.41 Encounter for autism screening
screening, per Z13.42 Encounter for screening for
instrument, scoring and global developmental delays
documentation (milestones)
96127 Brief emotional/behavioral Z13.31 Encounter for screening
for depression
assessment (eg,
depression inventory) Z13.39 Encounter for screening
examination for other mental
with scoring health and behavioral disorders
and documentation,
per standardized
instrument

Used to report administration of standardized developmental/autism

screening instruments (96110) or behavioral/social/emotional screening
instruments (96127). See page 10 for the definition of standardized.
Often reported when performed in the context of preventive medicine services
but may also be reported when screening or assessment is performed with other
E/M services (eg, acute illness or follow-upoffice visits).
Clinical staff (eg, registered nurse) typically administers and scores the
completed instrument, while the physician incorporates the interpretation
component into the accompanying E/M service.
When a standardized screening or assessment is administered along with any
E/M service (eg, preventive medicine service), both services should be reported,
and modifier 25 (significant, separately identifiable E/M service by the same
physician on the same day of the procedure or other service) may need to be
appended to the E/M code to show the E/M service was distinct and necessary at
the same visit.
Alternatively, some payers may require the use of code G0444 (annual
depression screening, 15 minutes) in lieu of code 96127 for the routine
depression screening.
For more information on reporting 96110 and 96127 instruments, refer to
[Link]
[Link].

11
Hearing
Screening
CPT Codes ICD-10-CM Codes
92551 Screening test, pure Z00.121 Routine child health exam
tone, air only with abnormal findings
92552 Pure tone audiometry Z00.129 Routine child health exam
(threshold), air only without abnormal findings

92567 Tympanometry
(impedance testing)
Requires use of calibrated electronic equipment; tests using other methods
(eg, whispered voice, tuning fork) are not reported separately.
Includes testing of both ears; append modifier 52 when a test is applied to
only one ear.
For newborn hearing screenings for young patients, including those
patients who are nonverbal or have developmental delays, other hearing
assessment methods may be more appropriate.

CPT Codes ICD-10-CM Codes

92558 Evoked otoacoustic emissions, Z00.110 Health supervision for
screening (qualitative newborn under 8 days old
measurement of distortion Z00.111 Health supervision for
product or transient evoked newborn 8 to 28 days old
otoacoustic emissions),
automated analysis Z00.121 Routine child health exam
with abnormal findings
92650 Auditory evoked potentials;
screening of auditory potential Z00.129 Routine child health exam
with broadband stimuli, without abnormal findings
automated analysis
92587 Distortion product evoked P09.6 Abnormal findings on
otoacoustic emissions; limited neonatal screening
evaluation (to confirm the
presence or absence of hearing
disorder, 3-6 frequencies) or
transient evoked otoacoustic
emissions, with interpretation
and report

92588 comprehensive diagnostic

evaluation, with interpretation and
report

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 Codes Z01.10 (encounter for examination of ears and hearing without
abnormal findings) and Z01.118 (encounter for examination of ears and
hearing with other abnormal findings) are reported only when a patient
presents for an encounter specific to ears and hearing, not for a routine well-
child examination at which a hearing screening is performed.
Failed hearing screenings will most likely result in a follow-up office visit
(eg, 99212–99215). Code Z01.110 (encounter for hearing examination
following failed hearing screening) is reported when a specific disorder
cannot be identified or when the follow-up hearing screening findings are
normal. You can also report Z01.118 (encounter for examination of ears and
hearing with other abnormal findings) and include the code for the
abnormal findings (eg, R94.120 [abnormal auditory function study]).

Vision Screening

CPT Codes ICD-10-CM Codes

99173 Screening test of visual acuity Z01.020 Encounter for examination of
quantitative, bilateral eyes and vision following failed
vision screening without
abnormal findings
Z01.021 Encounter for examination of
eyes and vision following failed
vision screening with abnormal
findings
Z00.121 Routine child health exam
with abnormal findings
99174 Instrument-based ocular Z00.129 Routine child health exam
screening (eg, photoscreening, without abnormal findings
automated-refraction), bilateral,
with remote-analysis and report
99177 Instrument-based ocular
screening (eg, photoscreening,
automated-refraction), bilateral,
with on-site analysis

Z01.00 and Z01.01 (examination of eyes and vision with and without abnormal
findings) are reported only for routine examination of eyes and vision, not
when a vision screening is done during a routine well-child examination.

To report code 99173, you must employ graduate visual acuity stimuli that allow
a quantitative estimate of visual acuity (eg, Snellen chart).

13
 Codes 99174 and 99177 are reported for instrument-based ocular
screening.
Code 99177 is reported in lieu of 99174 when the screening instrument
provides you with immediate pass or fail results.
When acuity (99173) or instrument-based ocular screening (eg, 99174)
is measured as part of a general ophthalmologic service or an E/M
service of the eye (eg, for an eye-related problem or symptom), it
is considered part of the diagnostic examination of the office or
other outpatient service code (99202–99215) and is not reported
separately.
Failed vision screenings could result in a follow-up office visit
(eg, 99212–99215). Report the follow-up screening with Z01.020
(encounter for examination of eyes and vision following failed
vision screening without abnormal findings) if normal results or
Z01.021 (encounter for examination of eyes and vision following
failed vision screening with abnormal findings) if abnormal
results. If abnormal, link to the diagnosis code for the reason for
the failure (eg, H52.1- [myopia]); when a specific disorder cannot
be identified, report R94.118 (abnormal results of other function
studies of eye).
IMMUNIZATIONS
Immunization Administration (IA)
Pediatric IA Codes

CPT Codes ICD-10-CM Codes

90460 Immunization administration (IA) Z23 Encounter for
through 18 years of age via any immunizations
route of administration, with
counseling by physician or other
qualified health care professional;
first or only component of each
vaccine or toxoid administered
+90461 each additional vaccine or
toxoid component
administered (List separately
in addition to code for
primary procedure.)

14
Component refers to all antigens in a vaccine that prevent diseases caused
by 1 organism. Multivalent antigens or multiple serotypes of antigens
against a single organism are considered a single component of vaccines.
Combination vaccines are vaccines that contain multiple vaccine
components. Conjugates or adjuvants contained in vaccines are not
considered to be component parts of the vaccine, as defined previously.
A QHP is an individual who is able to perform a professional service
within their scope of practice and to independently report a professional
service. These professionals are distinct from clinical staff. A clinical staff
member is a person who works under the supervision of a physician or
other QHP and who is allowed to perform or assist in the performance of
specified professional services but does not individually report any
professional services.
Code 90460 is used to report the first or only component in a single
vaccine given during an encounter. You can report 90460 more than once
during a single office encounter. Code 90461 is considered an add-on
code to 90460 (hence the + symbol next to it). This means that the
provider will use 90461 in addition to 90460 if more than
1 component is contained within a single vaccine administered. CPT
codes 90460 and 90461 are reported regardless of route of
administration.

Pediatric IA codes (90460, 90461) are reported only when both of the
following requirements are met:
1. The patient must be 18 years or younger.
2. The physician or other QHP must perform face-to-face vaccine
counseling associated with the administration.

NOTE: The clinical staff can do the actual administration of the

vaccine.

15
 If both of these requirements are not met, report a non–age-specific IA
code (90471–90474) instead.

Non–age-specific IA Codes
Report a CPT code for both the administration and product and an ICD-
10-CM code for each vaccine administered during a patient encounter.

90471 IA (includes percutaneous, intradermal, subcutaneous, or

intramuscular injections); one vaccine (single or
combination vaccine/toxoid)

+90472 Immunization administration (includes percutaneous,

intradermal, subcutaneous, or intramuscular injections);
each additional vaccine (single or combination
vaccine/toxoid) (List separately in addition to code for
primary procedure)

90473 IA (includes intranasal or oral administration); one

vaccine (single or combination vaccine/toxoid)

+90474 Immunization administration by intranasal or oral route;

each additional vaccine (single or combination
vaccine/toxoid) (List separately in addition to code for
primary procedure)

Codes 90471 and 90473 are used to code for the first immunization
given during a single office visit. Codes 90472 and 90474 are con-
sidered add-on codes (hence the + symbol next to them) to 90460, 90471,
and 90473. This means that the provider will use 90472 or 90474 in
addition to 90460, 90471, or 90473 if more than 1 vaccine is administered
during a visit. There can be only 1 first administration during a given
visit. (See vignettes 3, 4, and 5 on pages 21–23.)

16
 If during a single encounter for a patient 18 years or younger, a
physi- cian or other QHP only counsels on some of the vaccines,
report code 90460 (and 90461 when applicable) for those counseled
on and defer to codes 90472 or 90474, as appropriate, for those that
are not counseled on.

For IA Related to RSV and COVID-19 Immunizations See Our Vaccine

Coding Table
Vignette 1
A 2-month-old established patient presents for her checkup. The following
vaccines are ordered: Pentacel (diphtheria-tetanus-acellular pertussis
[DTaP], Haemophilus influenzae type b [Hib], inactivated poliovirus [IPV]),
pneumococcal, and rotavirus. The physician counsels the parents on all of
them, consent is obtained and the nurse administers them all.
How are the appropriate codes for this service selected?
Step 1: Select appropriate E/M code.
99391 Preventive medicine service, established
patient, infant (age younger than 1 year)
Step 2: Select appropriate vaccine product codes.

90698 DTaP-Hib-IPV (Pentacel) product

90670 Pneumococcal product
90680 Rotavirus vaccine, oral use

Step 3: Select appropriate IA codes by considering the following

questions:
Is the patient 18 years or younger?
If the patient is younger than 18 years, did the physician or other
QHP perform the face-to-face vaccine counseling, discussing the
specific risks and benefits of the vaccines?
If the answer to both questions is yes, select a code from the pediatric
IA code family (90460, 90461). If the answer to one of the questions is
no, select a code from the non–age-specific IA code family (90471–
90474).
In this vignette, the answer to both questions is yes. Therefore, IA
codes
90460 and 90461 will be reported.

17
Step 4: Select the appropriate ICD-10-CM diagnosis codes.
Diagnosis codes are used along with CPT codes to reflect the
outcome of a visit. The CPT codes tell a carrier what was done, and
ICD-10-CM codes tell a carrier why it was done.
The vaccine product CPT code and its corresponding IA CPT code are
always linked to the same ICD-10-CM code. This is because the vaccine
product and work that goes into administering that product are
intended to provide prophylactic vaccination against a certain type of
disease.
ICD-10-CM lists only a single code to describe an encounter in
which a patient receives a vaccine. The code is Z23, and it is
reported at any encounter when a vaccine is given, including
routine well-child or adult examinations.
The diagnosis codes for the 3 vaccines and 3 IA codes used in this
vignette are as follows:

CPT Codes ICD-10-CM

Codes
99391 25 Preventive medicine service, established Z00.129
patient,
<1 year
90698 DTaP-Hib-IPV (Pentacel) product Z23
90670 Pneumococcal product Z23
90680 Rotavirus vaccine, oral use Z23
90460 (×3) Pediatric IA (Pentacel, pneumococcal, Z23
rotavirus), first component
90461 (×4) Pediatric IA (Pentacel), each Z23
additional component

Vignette 2
A 5-year-old established patient is at a physician’s office for her annual
well-child examination. The patient is scheduled to receive her first
hepatitis A vaccine; her fifth DTaP vaccine; and the influenza vaccine.
After distributing the Vaccine Information Statements and
discussing the risks and benefits of immunizations with her parents,
the physician administers the vaccines.
How are the appropriate codes for this service selected?

18
Step 1: Select appropriate E/M code.
99393 Preventive medicine service, established patient, age 5 to 11
years
Step 2: Select appropriate vaccine product codes.
90633 Hepatitis A vaccine, pediatric/adolescent dosage
(2-dose schedule), for intramuscular use
90700 DTaP, for use in individuals younger than 7 years, for
intramuscular use
90686 Influenza virus vaccine, quadrivalent (IIV4), split virus,
preservative free, 0.5 mL dosage, for IM use
Step 3: Select appropriate IA codes by considering the following questions:
Is the patient 18 years or younger?
If the patient is younger than 18 years, did the physician or other
qualified health care professional perform the face-to-face vaccine
counseling, discussing the specific risks and benefits of the vaccines?
If the answer to both questions is yes, select a code from the pediatric IA
code family (90460, 90461). If the answer to one of the questions is no, select
a code from the non–age-specific IA code family (90471–90474).
In this vignette, the answer to both questions is yes. Therefore, IA codes
90460 and 90461 will be reported.
Step 4: Select the appropriate ICD-10-CM diagnosis codes.
Diagnosis codes are used along with CPT codes to reflect the outcome of a
visit. The CPT codes tell a carrier what was done, and ICD-10-CM codes tell
a carrier why it was done.
The vaccine product CPT code and its corresponding IA CPT code are always
linked to the same ICD-10-CM code. This is because the vaccine product and
work that goes into administering that product are intended to provide
prophylactic vaccination against a certain type of disease.
ICD-10-CM lists only a single code to describe an encounter in which a
patient receives a vaccine. The code is Z23, and it is reported at any
encounter when a vaccine is given, including routine well-child or adult
examinations.

19
The diagnosis codes for the 3 vaccines and 3 IA codes used in
this vignette are as follows:
CPT Codes ICD-10-CM
Codes
99393 25 Preventive medicine service, established Z00.129
patient, 5–11 years
90633 Hepatitis A vaccine product Z23
90460 Pediatric IA (hepatitis A vaccine), first Z23
component
90700 DTaP vaccine product Z23
90460 Pediatric IA (DTaP vaccine), first Z23
component
90461 (×2) Pediatric IA (DTaP vaccine), each Z23
additional component
90656 Influenza virus vaccine, trivalent (IIV3), Z23
split virus, preservative free, 0.5 mL
dosage, for IM use
90460 Pediatric IA (influenza vaccine), first Z23
component

NOTE: Some payers do not want multiple line items of codes 90460 or
90461; therefore, follow the coding example below.

CPT Codes ICD-10-CM

Codes
99393 25 Preventive medicine service, established Z00.129
patient, 5–11 years
90633 Hepatitis A vaccine product Z23
90700 DTaP vaccine product Z23
90656 Influenza virus vaccine, trivalent (IIV3), split Z23
virus, preservative free, 0.5 mL dosage, for IM
use
90460 (×3) Pediatric IA (hepatitis A, DTaP, influenza Z23
vaccines), first component
90461 (×2) Pediatric IA (DTaP vaccine), second and third Z23
components

20
Rationale
Because the patient is younger than 18 years and there is physician coun-
seling, pediatric IA codes are reported (90460 and 90461). Each vaccine
administered will be reported with its own 90460 (hepatitis A, DTaP, and
influenza). The only vaccine with multiple components is DTaP. Because
the first component (ie, diphtheria) was counted in 90460, only the second
and third components (ie, tetanus and acellular pertussis) are reported
with 90461 with 2 units.

Vignette 3
A 19-year-old patient presents to the office to complete a college physical
examination (in college the patient will be living in a dormitory). He is due
for a tetanus-diphtheria-acellular pertussis (Tdap) booster, meningococcal
vaccine, and intranasal influenza vaccine. The physician counsels the patient
on each, and the nurse administers each.
CPT Codes ICD-10-CM
Codes
99395 25 Preventive medicine service, Z02.0
established patient, 18–39 years
90715 Tdap product Z23
90471 IA, first injection Z23
90734 Meningococcal conjugate vaccine Z23
(MenACWY-D or MenACWY-CRM)
90472 IA, each additional injection Z23
90660 Influenza virus vaccine, trivalent, live Z23
(LAIV3), for intranasal use
90474 IA, each additional oral or intranasal Z23

Rationale
The patient is older than 18 years; therefore, despite physician
counseling, pediatric IA codes cannot be reported. Instead, codes 90471
and 90474 must be used.

21
Vignette 4
A 17-year-old patient presents to the office for her annual checkup and
to complete a college physical examination (in college the patient will
be living in a dormitory). The patient is healthy and due for a Tdap
booster, meningococcal vaccine, first HPV (9-valent) vaccine, and
influenza vaccine. The physician counsels the patient only on the
meningococcal and HPV vaccines, and the nurse administers each.
The patient is asked to return in 4 to 6 weeks for her second HPV
vaccine.

CPT Codes ICD-10-CM

(First Visit Codes
Only) (First Visit
Only)
99395 25 Preventive medicine service, Z00.00 and
established patient, 12–17 years Z02.0
90734 Meningococcal (MCV4) product Z23
90651 HPV (9-valent) product Z23
90460 (×2) Pediatric IA (meningococcal and Z23
HPV), first component
90715 Tdap product Z23
90472 (×2) IA, each additional injection (Tdap) Z23
90656 Influenza virus vaccine, trivalent Z23
(IIV3), split virus, preservative free, 0.5
mL dosage, for IM use

Rationale
Because the physician documents counseling only for the
meningococcal and HPV vaccines, code 90460 can be reported only for
those vaccines because the patient meets the age criteria. For the Tdap
and influenza vaccines, defer to non-pediatric IA codes (90471, 90472).
In this case, however, a first vaccine code is already reported with code
90460, so the additional IA code 90472 has to be reported. While ICD-
10-CM does not provide official ages for the “adult” ICD-10-CM codes
(Z00.00 and Z00.01) in lieu of the well-child examination codes, many
payers use age 17 years as the cutoff. Refer to specific payer policy for
details.

22
Vignette 5
A 6-month-old patient presents to the office for her routine checkup
and to receive vaccines. The patient is due for DTaP, pneumococcal,
and hepa- titis B vaccines. During the examination, the physician finds
an upper respiratory infection and fever. The physician counsels the
parent on the vaccines but decides to defer for 2 weeks. The physician
completes the well-baby checkup on that day.
Two weeks later, the patient returns. The patient is afebrile and
asymptom- atic and is seen only by the nurse. The DTaP, pneumococcal,
and hepatitis B vaccines are administered.

CPT Code ICD-10-CM Code

(First (First Visit)
Visit)
99391 Preventive medicine service, Z00.121
established patient, <1 year
An appropriate acute sick visit (eg, 99213) may be reported in addition with
modifier 25
and linked to an appropriate ICD-10-CM code.
CPT Codes ICD-10-CM Codes
(2 Weeks Later) (2 Weeks Later)
90700 DTaP product Z23
90670 Pneumococcal product Z23
90744 Hepatitis B vaccine product Z23
90471 IA (DTaP), first vaccine Z23
90472 (×2) IA (pneumococcal, hepatitis B), Z23
each additional vaccine

Rationale
If counseling occurs outside the IA service, there is no way to report it
separately. Therefore, in this vignette, there is nothing separate to report
during the well-baby visit, and when the patient returns and sees only the
nurse, pediatric IA codes cannot be reported; defer to codes 90471–90474.
During the preventive medicine service, when an acute illness is detected,
a code from 99212–99215 can be reported if the service is significant and
separately identifiable. Code 9921x is reported with modifier 25. When the
patient returns only for vaccines, an E/M service is not reported. The ICD-10-
CM code will be reported for with abnormal findings (Z00.121) because an
abnormality was identified during the encounter.
For more information on IA codes, refer to the AAP's coding website
([Link]/coding) and its page dedicated to vaccine coding.
22
Coding Guidelines When Immunizations Are Not Administered
ICD-CM-10 Codes
For many reasons, immunizations are not given during routine pre-
ventive medicine services. Parents may refuse vaccines or defer them, a
patient may be ill at the time and it is counteractive to administer, or the
patient may already have had the disease or be immune.
Because of tracking purposes and quality measures, it is important to
report non-administration as part of the ICD-10-CM codes. The
following ICD-10-CM codes were created to report why a vaccine is not
given:

Z28.01 Acute illness

Z28.02 Chronic illness or condition
Z28.03 Immunocompromised state
Z28.04 Allergy to vaccine or component
Z28.1 Religious reasons
Z28.20 Unspecified reason
Z28.21 Patient refusal
Z28.81 Patient had disease
Z28.82 Caregiver refusal
Z28.83 Vaccine was unavailable (eg, manufacturer delay)
Z28.89 Other reason

Vignette

A 1-year-old presents for his routine well-child examination. He is

scheduled to receive his first measles, mumps, rubella; hepatitis A;
and varicella vaccines. Because he had a documented case of varicella
when he was 9 months of age, the varicella vaccine is not given.
Report the following ICD-10-CM codes linked to the E/M service:

Z23 Encounter for immunization

Z28.81 Immunization not carried out due to patient
having had the disease

23
 VACCINES FOR CHILDREN PROGRAM

The rules for reporting vaccines for patients who qualify for the
Vaccines for Children (VFC) program vary greatly. Some states require
that the product code be submitted, while others require the IA codes.
Some require the use of modifiers, while others do not. Currently, the
VFC program does not recognize component-based vaccine
counseling; there- fore, you will not be paid for CPT code 90461. The
American Academy of Pediatrics continues to work on changing this
so pediatric providers can be properly compensated for giving
multiple-component vaccines.

Also be sure to check with your individual state Medicaid plan for
varying rules, including, but not limited to, being able to report code
99211 in addition to IA codes for vaccine-only encounters. Be sure to
get these rules in writing.

Our Vaccine Coding Table has the most up-to-date CPT codes
for all Pediatric Immunizations

LABORATORY
Two different practice models surround the conducting of laboratory
tests: blood is drawn in office and specimen is sent to an outside
laboratory for analysis, or blood is drawn and laboratory tests are
performed in the physician’s practice. Never report the laboratory code
for a laboratory test that the practice does not run in-house or is not
financially responsible for and billed by the outside laboratory. In those
cases, report only the blood draw and specimen handling, as
appropriate.

Model 1: Blood is drawn in office and specimen is taken to an outside

laboratory for analysis.
CPT Code
99000 Handling and/or conveyance of specimen for transfer
from the physician’s office to a laboratory

24
 Venipuncture CPT Codes

36406 Venipuncture, younger than 3 years, necessitating physician’s

skill, not to be used for routine venipuncture
36410 Venipuncture, 3 years or older, necessitating physician’s
skill, for diagnostic or therapeutic purposes (not to be used
for routine venipuncture)
36415 Collection of venous blood by venipuncture
36416 Collection of capillary blood specimen (eg, finger, heel, ear
stick)
Venipuncture ICD-10-CM Codes
Link to ICD-10-CM codes for the well-child examination or for
specific screening tests.

Model 2: Blood is drawn and laboratory tests are performed in the

physician’s practice.
Venipuncture CPT Codes

36406 Venipuncture, younger than 3 years, necessitating physician’s

skill, not to be used for routine venipuncture

36410 Venipuncture, 3 years or older, necessitating physician’s skill,

for diagnostic or therapeutic purposes (not to be used for routine
venipuncture)

36415 Collection of venous blood by venipuncture

36416 Collection of capillary blood specimen (eg, finger, heel, ear

stick)

Venipuncture ICD-10-CM Codes

Link to ICD-10-CM codes for the well-child examination or for
specific screening tests.

25
Anemia Screening CPT Code
85018 Blood count; hemoglobin

Anemia Screening ICD-10-CM Code

Z13.0 Encounter for screening for diseases of the blood and
blood-forming organs and certain disorders involving the
immune mechanism (eg, anemia)

Bilirubin CPT Codes

82247 Bilirubin, total
88720 Bilirubin, total, transcutaneous

Bilirubin ICD-10-CM Code

Z13.228 Encounter for screening for other metabolic
disorder

Dyslipidemia Screening CPT Codes

80061 Lipid panel (includes total cholesterol, high-density
lipoprotein
[HDL] cholesterol, and triglycerides)
82465 Cholesterol, serum, total
83718 Lipoprotein, direct measurement, high-density
cholesterol (HDL cholesterol)
84478 Triglycerides

Dyslipidemia Screening ICD-10-CM Code

Z13.220 Encounter for screening for lipid disorders

Hepatitis B Screening CPT Codes

86704 Hepatitis B core antibody (HBcAb); total
86705 IgM antibody
86706 Hepatitis B surface antibody (HBsAb)
86707 Hepatitis Be antibody (HBeAb)
87340 Infectious agent antigen detection by immunoassay technique
qualitative or semiquantitative hepatitis B surface antigen
(HBsAg)

26
Hepatitis B Screening ICD-10-CM Code
Z20.5 Contact with and (suspected) exposure to viral hepatitis
Z11.59 Encounter for screening for other viral diseases

Hepatitis C Screening CPT codes

86803 Hepatitis C antibody;
86804 Hepatitis C antibody; confirmatory test (eg,
immunoblot)
87520 Infectious agent detection by nucleic acid (DNA or
RNA); hepatitis C, direct probe technique
87521 Infectious agent detection by nucleic acid (DNA or
RNA); hepatitis C, amplified probe technique, includes
reverse transcription when performed
Hepatitis C Screening ICD-10-CM Code
Z20.5 Contact with and (suspected) exposure to viral
Z11.59 hepatitis Encounter for screening for other viral
diseases

Lead Screening CPT Code

83655 Lead

Lead Screening ICD-10-CM Code

Z13.88 Encounter for screening for disorder due to exposure

to contaminants

Newborn Metabolic Screening HCPCS Code

S3620 Newborn metabolic screening panel, includes test kit,

postage, and the laboratory tests specified by the state for
inclusion in this panel (eg, galactose; hemoglobin,
electrophoresis; hydroxyprogesterone, 17-D; phenylalanine
[phenylketonuria (PKU)]; and thyroxine, total)

NOTE: Only report code S3620 if you are billing for the actual
running of the laboratory test or test kit. Otherwise only report
the appropriate blood collection code (eg, 36416).

27
Newborn Metabolic Screening ICD-10-CM Codes
Report the diagnosis codes for the state-specific newborn screening tests
conducted. Examples include:

Z13.0 Encounter for screening for diseases of the blood and blood-
forming organs and certain disorders involving the immune
mechanism (eg, anemia, sickle cell)

Z13.21 Encounter for screening for nutritional disorder

Z13.228 Encounter for screening for other metabolic disorders (eg, PKU,
galactosemia)

Z13.29 Encounter for screening for other suspected endocrine disorder

(eg, thyroid)

Papanicolaou Smear HCPCS Code

Q0091 Screening Papanicolaou smear; obtaining, preparing, and
conveyance of cervical or vaginal smear to laboratory
Papanicolaou Smear CPT Code
Collection of a cervical specimen via a pelvic examination is included in the
preventive medicine service code (99381–99385 and 99391–99395).

Papanicolaou Smear ICD-10-CM Codes

Z12.4 Encounter for screening for malignant neoplasm of cervix
(excludes HPV)
Z12.72 Encounter for screening for malignant neoplasm of vagina
Z12.79 Encounter for screening for malignant neoplasm of other
genitourinary organs
Z12.89 Encounter for screening for malignant neoplasms of other sites

Tuberculosis Testing (Mantoux/Purified Protein Derivative

[PPD])
Administration of PPD Test
CPT Code ICD-10-CM Code
86580 Skin test; Z11.1 Encounter for screening
tuberculosis, for respiratory
intradermal tuberculosis

NOTE: Administration of the PPD test is inclusive of CPT

86580 and cannot be separately reported.

28
Reading of PPD Test
If patient returns to have a nurse read the test results, report:
CPT Codes ICD-10-CM Codes
99211 Office or other Z11.1 Encounter for screening
outpatient services for respiratory
(negative PPD outcome) tuberculosis (if test is
negative)
99212–99215 Office or outpatient R76.11 Nonspecific reaction to
services (physician tuberculin skin
service for positive tuberculosis (if test is
encounter) positive)

Sexually Transmitted Infection and HIV Screening CPT Codes

86701 Antibody; HIV-1
86703 Antibody; HIV-1 and HIV-2; single assay
87490 Infectious agent detection by nucleic acid (DNA or RNA);
Chlamydia trachomatis, direct probe technique
87491 Infectious agent detection by nucleic acid (DNA or RNA);
C trachomatis, amplified probe technique
87590 Infectious agent detection by nucleic acid (DNA or RNA);
Neisseria gonorrhoeae, direct probe technique
87591 Infectious agent detection by nucleic acid (DNA or RNA);
N gonorrhoeae, amplified probe technique
87810 Infectious agent detection by immunoassay with direct
optical observation; C trachomatis
87850 Infectious agent detection by immunoassay with direct
optical observation; N gonorrhoeae
Sexually Transmitted Infection and HIV Screening ICD-10-CM Codes
Z11.3 Encounter for screening for infections with a predominantly
sexual mode of transmission (excludes HPV and HIV)
Z11.8 Encounter for screening for other infectious and parasitic
diseases (eg, chlamydia)

29
 HEALTHCARE COMMON PROCEDURE CODING SYSTEM CODES
The HCPCS Level II codes are procedure codes used to report services
and supplies not included in the CPT nomenclature.
Like CPT codes, HCPCS Level II codes are part of the standard
procedure code set under the Health Insurance Portability and
Accountability Act of 1996.
Certain payers may require that HCPCS codes be reported in lieu of
or as a supplement to CPT codes.
The HCPCS nomenclature contains many codes for reporting
nonphysician provider patient education, which can be an integral
service in the provision of pediatric preventive care.
Examples of HCPCS Level II codes relevant to pediatric preventive
care include:

S0302 Completed Early and Periodic Screening, Diagnosis, and

Treatment service (List in addition to code for appropriate
E/M service.)
S0610 Annual gynecologic examination; new patient Annual
S0612 Annual gynecologic examination; established patient
S0613 Annual gynecologic examination, clinical breast examination
without pelvic examination
S0622 Routine examination for college, new or established patient (List
separately in addition to appropriate E/M code.)
S9444 Parenting classes, nonphysician provider, per session
S9445 Patient education, not otherwise classified, nonphysician
provider, individual, per session
S9446 Patient education, not otherwise classified, nonphysician
provider, group, per session
S9447 Infant safety (including cardiopulmonary resuscitation) classes,
nonphysician provider, per session
S9451 Exercise classes, nonphysician provider, per session
S9452 Nutrition classes, nonphysician provider, per session
S9454 Stress management classes, nonphysician provider, per session

30
 Commonly Reported ICD-10-CM Codes for Pediatric Preventive Services

Encounter and Examination Codes

ICD-10-CM Descriptor Special
Code Coding
Conventions
Z00.110 Newborn check under 8 days old Outpatient codes only
Z00.111 Newborn check 8 to 28 days old Outpatient codes only
Z00.121 Routine child health examination First-listed ICD-10-CM
with abnormal findings code only.
Z00.129 without abnormal findings
Z00.00 General adult medical examination First-listed ICD-10-CM
without abnormal findings code only.
Z00.01 with abnormal findings Typically used for
patients 18 years and
older
(payer policy).

Z02.0 Examination for admission to Not required in

educational institution addition to a Z00
code
Z02.4 Examination for driving license
Z02.5 Examination for participation in sport
Z01.110 Hearing examination First-listed ICD-10-
following failed hearing CM code only. Do
screening not report as a
secondary code or in
addition to a Z00
code.

Z23 Immunizations This is the only code

in ICD-10-CM for
vaccines. Link to
both the product
and administration
CPT codes.

Z29.3 Encounter for prophylactic

fluoride administration

31
ICD-10-CM Descriptor
Code
Screening Codes

Z11.1 Respiratory tuberculosis

Z11.3 Infections with a predominantly sexual mode of
transmission (excludes HPV and HIV)
Z12.4 Malignant neoplasm of cervix (excludes HPV)
Z11.51 Human papillomavirus (HPV)
Z11.59 Other viral diseases (eg, Hep B)
Z12.79 Malignant neoplasm of other genitourinary organs
Z12.89 Malignant neoplasms of other sites
Z13.0 Diseases of the blood and blood-forming organs and
certain disorders involving the immune mechanism
(eg, anemia, sickle cell)
Z13.1 Diabetes mellitus
Z13.21 Nutritional disorder
Z13.220 Lipid disorders
Z13.228 Other metabolic disorders (eg, inborn errors of
metabolism, galactosemia, PKU)
Z13.29 Other endocrine disorder
Z13.31 Depression screening
Z13.39 Encounter for screening examination for other
mental health and behavioral disorders
(eg, alcoholism, suicide ideation)
Z13.41 Autism screening
Z13.42 Global developmental delays (milestones)
screening
Z13.88 Disorder due to exposure to contaminants (eg,
lead)
Z13.89 Other specified disorders (not listed here)

32
ICD-10-CM Descriptor Special
Code Coding
Conventions
Preventive Counseling
Z71.3 Dietary surveillance and counseling
Z71.82 Exercise counseling
Z71.84 Health counseling related to travel
Z71.89 Other specified counseling
Z71.9 Counseling, unspecified
Underimmunized Status
Z28.3 Underimmunized status A status code is
informative and
may affect the
course
of treatment
and its outcome.
Report
when this is the
case.
Vaccines Not Given
Z28.01 Acute illness
Z28.04 Allergy to vaccine or components
Z28.82 Caregiver refusal
Z28.02 Chronic illness or condition
Z28.03 Immune compromised state
Z28.21 Patient refusal
Z28.81 Patient had disease being vaccinated for
Z28.1 Religious reasons
Z28.89 Other reason
Z28.83 Vaccine was unavailable (eg,
manufacturer delay)
Z28.20 Unspecified reason

33
 Social Determinants of Health
When identified during a routine preventive medicine service encounter,
either through a formal screening instrument or surveillance, they should
be addressed as appropriate and coded for. Listed below are a few of the
SDOH codes in the ICD-10-CM code set; however, always refer to the
larger code set for others. For more information on coding for SDOH
issues and services visit [Link]
Social Determinants Of Health
Abuse
T74.02- Child neglect or abandonment
T74.12- Child physical abuse
T74.22- Child sexual abuse
T74.32- Child psychological abuse
T74.52- Child sexual exploitation
T74.62- Child forced labor exploitation
Z62.81- Personal history of abuse in childhood
Z69- Encounter for mental health services for victim of abuse
Economic
Z59.5 Extreme poverty
Z59.6 Low income
Z59.7 Insufficient social insurance and welfare support
Family Issues
Z63.31 Absence of family member due to military deployment
Z63.32 Other absence of family member
Z63.4 Disappearance and death of family member
Z63.5 Disruption of family by separation and divorce
Z63.72 Alcoholism and drug addiction in family
Z63.79 Other stressful life events affecting family and household
Z62.82- Parent-child conflict
Z62.890 Parent-child estrangement NEC
Food & Water Issues
Z59.41 Food insecurity
Z58.6 Unsafe drinking-water supply
Living situation
Z62.21 Child in welfare custody
Z59.0- Homelessness
Z59.81 Housing instability
- Indicates another character is required to complete the code.
34
Social Determinants Of Health
Z62.22 Institutional upbringing
Z62.29 Other upbringing away from parents
Social Issues
Z60.3 Acculturation difficulty
Z60.4 Social exclusion and rejection
Z60.5 Target of (perceived) adverse discrimination and persecution

Healthcare Effectiveness Data and Information Set Measures Related

to Pediatric Preventive Care

Measure Topic Measure Coding Options

Child and Adolescent At least 6 well-child ICD-10-CM
Well-Care Visits: Well- examinations by 15 Z00.110,
Child Visits in the First months of age Z00.111,
15 Months of Life (W15) Z00.121,
Z00.129
CPT
99381, 99382,
99391, 99392
Child and Adolescent One or more ICD-10-CM
Well-Care Visits: Well- comprehensive well- Z00.121, Z00.129
Child Visits in the Third, child visits with a CPT
Fourth, PCP (per year) 99382, 99392
Fifth, and Sixth Years of
Life (W34)
Child and Adolescent At least one annual ICD-10-CM
Well-Care Visits: comprehensive Z00.00,
Adolescent Well-Care well-care Z00.01,
Visits (AWC) encounter (per Z00.121,
year) for Z00.129
adolescents and CPT
young adults aged 99384, 99385,
12–21 years 99394, 99395
Lead Screening in By age 2 years, have had CPT
Children (LSC) one or more capillary or 83655
venous lead blood tests
for lead poisoning
Chlamydia Screening in Sexually active women CPT
Women (CHL) aged 16–24 years who 87110, 87270,
received at least one 87320, 87490–
chlamydia test each 87492,
year 87810

35
 Healthcare Effectiveness Data and Information Set Measures Related
to Pediatric Preventive Care (continued)
Measure Topic Measure Coding Options
Childhood By age 2 y, have Varies; refer to the
Immunizatio DTaP (4 doses) Commonly
n Status (CIS) IPV (3 doses) Administered
and MMR (1 dose) Pediatric Vaccines
Immunizatio Hib (3 doses) table on pages 25–
ns for Hep B (3 28 for specific
Adolescents doses) vaccine codes.
(IMA) Varicella (1
dose)
Pneumococcal (4
doses) Hep A (1
dose) Rotavirus (2–
3 doses)
Influenza (2 doses)
By 13th birthday, have
Meningococcal (1 dose)
(Ages 11–13 y)
Tdap (1 dose)
(Ages 10–13 y)
HPV (males/females) (2–3
doses) (Ages 9–13 y)
Weight For those aged 3–17 years ICD-10-CM a
Assessment and who had an outpatient Z68.51–Z68.54,
Counseling for visit with a PCP during Z71.3, Z02.5,
Nutrition and the measurement year Z71.82
Physical Activity and had evidence of BMI CPT
for Children/ percentile documentation 3000Fa
Adolescents and counseling for
(WCC) nutrition and/or physical
activity
Abbreviations: BMI, body mass index; CPT, Current Procedural Terminology; DTaP, diphtheria,
tetanus, acellular pertussis; Hep A, hepatitis A; Hep B, hepatitis B; Hib, Haemophilus influenzae type
b; HPV, human papillomavirus; ICD-10-CM, International Classification of Diseases, 10th Revision,
Clinical Modification; IPV, inactivated poliovirus; MMR, measles, mumps, rubella; PCP, primary care
practitioner; Tdap, tetanus, diphtheria, acellular pertussis.
a
Body mass index codes should only be reported when there is a related condition (eg, obesity). Payers
need to accept 3000F in lieu of BMI ICD-10-CM codes for the BMI measure unless the patient has a
related condition.

36
 Clinical Bright Futures Resources

Bright Futures Tool and Resource Kit, 2nd Edition

This online resource provides health care professionals with an
organized and integrated compilation of current forms and materials
needed to perform a well-child visit on one website. The new online
platform allows easy access to the core tools for health supervision
visits, including pre-visit questionnaires, visit documentation forms,
parent and patient education handouts, and additional
documentation forms and AAP-developed educational resources.
Bright Futures: Guidelines for Health Supervision of Infants, Children,
and Adolescents, 4th Edition
This essential resource provides key background information and
recommendations for themes critical to healthy child development
along with well-child supervision standards for 31 age-based visits—
from newborn through 21 years.

Pediatric Coding Resources

Coding for Pediatrics 2025: A Manual for Pediatric Documentation and

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Pediatric ICD-10-CM 2025: A Manual for Provider-Based Coding, 10th
Edition This convenient resource condenses the vast ICD-10-CM code set
into 500+ pages of pediatric-related codes and guidelines.
AAP Pediatric Coding Newsletter
This print and online monthly publication brings you proven coding
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To order these and other pediatric resources,

visit [Link].