CPT
90471 — Immunization administration, single vaccine
ACA-covered vaccines should be free, including the admin fee.
Preventive care
99381 — Preventive medicine, new patient; infant younger than 1 year
This code covers a well-child visit for a new patient under 1 year old, including a comprehensive age-appropriate history, physical examination, anticipatory guidance, and ordering of routine screenings.
- Typical setting: Doctor's office
- National avg charge (illustrative): $130-$230 Medicare allowed amount is not applicable (this is a commercial/Medicaid code; commercial payer range $160-$280)
- Most-disputed reason: Wrong age bracket: billing 99381 when the infant has already turned 1 — use 99382 for ages 1-4
What it means
What 99381 actually means
This code covers a well-child visit for a new patient under 1 year old, including a comprehensive age-appropriate history, physical examination, anticipatory guidance, and ordering of routine screenings. These visits are not driven by a specific illness and focus entirely on wellness, growth, development, and preventive services.
Common errors with this code
What goes wrong on real bills.
Most bills that look correct still contain at least one of these issues. Up to 49% of medical bills contain errors (CFPB).
- Wrong age bracket: billing 99381 when the infant has already turned 1 — use 99382 for ages 1-4
- New vs. established error: billing 99381 instead of 99391 for a child seen in the practice within the past 3 years
- Unbundling: separately billing an E/M office visit code (99212-99215) for management of stable conditions that are within the scope of a preventive visit without documenting a separate, significant problem-oriented service with modifier -25
If you see 99381 on your bill
Three steps before paying.
1. Get the itemized bill. If your statement only shows a summary, request the CPT-level itemized bill before paying. Generate the request language →
2. Cross-check against the EOB. Compare what your insurer's Explanation of Benefits says you owe versus what the hospital is asking. They disagree more often than people think. Read the bill-vs-EOB guide →
3. Run a free Bill Scan. Upload the bill (and EOB if you have it) and BillBusted will flag the most likely issues with this specific code in your specific state. Run free scan →
Related codes
Other codes in this category.
People who land on 99381 often also see these adjacent codes on the same bill.
CPT
90472 — Immunization admin; each additional vaccine
Vaccine — admin (90471) is separate from the vaccine product code.
CPT
90651 — Human papillomavirus vaccine types 6, 11, 16, 18, 31, 33, 45, 52, 58, nonavalent , IM
Vaccine — admin (90471) is separate from the vaccine product code.
CPT
90670 — Pneumococcal conjugate vaccine, 13 valent , IM
Vaccine — admin (90471) is separate from the vaccine product code.
CPT
90671 — Pneumococcal conjugate vaccine, 15 valent , IM
Vaccine — admin (90471) is separate from the vaccine product code.
CPT
90677 — Pneumococcal conjugate vaccine, 20 valent , IM
Vaccine — admin (90471) is separate from the vaccine product code.
Related BillBusted guides
Plain-English reads if you see 99381 on a bill.
99381 FAQ
Plain-English answers.
What does 99381 usually cost?
$130-$230 Medicare allowed amount is not applicable (this is a commercial/Medicaid code; commercial payer range $160-$280). Costs vary by region, payer contract, and whether the service was performed in a hospital outpatient department (which adds a facility fee) versus a free-standing clinic.
What's the most common billing error on 99381?
Wrong age bracket: billing 99381 when the infant has already turned 1 — use 99382 for ages 1-4
What should I do if I see 99381 on my bill?
Request the itemized bill and the matching EOB from your insurer. Compare the units/quantity billed against what you actually received. Run a free BillBusted scan to flag the most likely errors specific to 99381 before paying.
Don't pay 99381 blindly.
The free scan tells you in under 60 seconds whether this charge looks reasonable for your situation.