Most Common Pediatric CPT Codes: Updated Guidelines for 2025
- Sirius solutions global
- Dec 23, 2025
- 3 min read
Updated: 2 days ago
Pediatric care is all about those routine check-ups, vaccinations, and quick fixes for ear infections or fevers that keep kids healthy and growing strong. But behind the scenes, getting the billing right with the most common pediatric CPT codes can make or break a practice's finances. With frequent well-child visits, immunizations, and preventive screenings, accurate coding ensures you capture every reimbursable service while staying compliant.
This detailed guide to the most common pediatric CPT codes in 2025 covers the essentials: top codes for preventive care, E/M visits, vaccines, newborn services, and more. We'll include the latest AMA updates, documentation tips, modifier usage, and strategies to avoid denials. Perfect for pediatricians, nurse practitioners, practice managers, and billers looking to streamline revenue in a busy clinic.
At Sirius Solutions Global, we've helped pediatric practices nationwide optimize their revenue cycle with specialty-focused billing. Our AI tools and expert team handle complex pediatric coding, so you can focus on patient care.
Pediatric billing is unique high volume of preventive services, bundled vaccines, age-specific codes, and strict medical necessity rules from payers. Denials often hit 10-15% higher in pediatrics due to mismatched codes or incomplete documentation.
The AMA's 2025 updates include refinements for telehealth, new vaccine codes, and enhanced remote monitoring options, reflecting growing virtual care and chronic condition management in kids. Mastering these most common pediatric CPT codes helps maximize reimbursements and reduce A/R days.
Preventive Medicine and Well-Child Visits
Well-child exams are the bread-and-butter of pediatrics, following Bright Futures guidelines.
New Patients: 99381-99385 (age-based, infant through adolescent)
Established Patients: 99391-99395 (most frequently used)
These include developmental screenings, vision/hearing tests, and anticipatory guidance.
Office/Outpatient E/M Visits (Sick Visits)
For acute issues like infections or injuries:
New Patients: 99202-99205
Established Patients: 99212-99215 (99213 and 99214 are top volume)
Coded by medical decision-making (MDM) or time in 2025.
Vaccine Administration and Products
Immunizations drive volume separate product and administration codes.
Administration: 90460 (first component with counseling), +90461 (additional components)
Common Products: Vary by vaccine (e.g., 90651 for HPV, 90707 for MMR)
Use Z23 for encounter for immunization.
Newborn and Hospital Care
Initial Hospital Care: 99460-99463
Attendance at Delivery: 99464
Critical Care: 99468-99469
Other High-Volume Codes
Developmental Screening: 96110
Vision Screening: 99173
Hearing Screening: 92551
Circumcision: 54150-54161
Here's a quick reference table for the most common pediatric CPT codes in 2025:
Telehealth Expansion: New codes for audio-video (98000–98007) and audio-only (98008–98015), plus brief assessments (98016).
Vaccine Changes: New codes like 90593; component-based administration emphasized.
Remote Monitoring: Enhanced RTM codes for chronic conditions like asthma.
No Major Preventive Shifts: Well-child codes stable, but focus on bundling.
Always check NCCI edits and payer policies e.g., some require modifiers for same-day sick + well visits (-25 on E/M).
Documentation Best Practices for Pediatric CPT Codes
Strong notes prevent denials:
Age-specific details (growth charts, milestones).
Counseling time for vaccines.
MDM justification for higher-level E/M.
Separate reports for screenings.
Use EHR templates to capture everything.
Top pitfalls:
Missing -25 for sick + preventive.
Incorrect vaccine components.
Upcoding well visits.
No Z codes for preventive.
Fixes: Scrub claims, audit regularly, train on updates.
Telehealth in Pediatrics: 2025 Guidelines
Bill with -95 modifier, POS 02. Many preventive and E/M codes qualify—great for follow-ups.
Pediatric practices face unique challenges high preventive volume, vaccine inventory, and family dynamics. At Sirius Solutions Global, our pediatric-focused RCM services include accurate coding for these most common pediatric CPT codes, denial appeals, and eligibility verification.
We've helped clinics boost collections by 20%+ with tools like CODIN for coding and ELIXA for checks. Explore more at https://siriussolutionsglobal.com/.
FAQs: Most Common Pediatric CPT Codes
What are the top well-child CPT codes?
99391-99395 for established patients.
How to bill vaccines correctly?
90460/90461 + product code; document counseling.
Can I bill sick and well same day?
Yes, with -25 on sick E/M.
2025 telehealth changes for peds?
New dedicated codes for virtual visits.
Best modifier for procedures?
-25 for significant separate E/M.
Wrapping Up: Optimize with the Most Common Pediatric CPT Codes in 2025
Staying on top of these most common pediatric CPT codes ensures healthier revenue and better patient outcomes. With proactive coding and expert support, your practice can thrive.
Ready for seamless pediatric billing? Contact Sirius Solutions Global for a free audit.
Updated December 22, 2025. Verify with AMA/CMS for changes.
