CPT 99383
Global XXXPrev visit new age 5-11
CPT 99383 Billing & Documentation Guide
CPT code 99383 (Prev visit new age 5-11) is classified under E/M with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 1.7, a non-facility practice expense RVU of 1.9, and a malpractice RVU of 0.11, a total non-facility RVU of 3.71 and facility RVU of 2.18. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $127.32, though rates vary from $113.19 to $156.51 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 99383, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 99383 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Non-covered service
No global period (E/M and other non-procedural services)
MUE Limit (Medically Unlikely Edits)
Submitting more than 0 units of 99383 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 99383
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.7 | 1.7 |
| Practice Expense RVU | 1.9 | 0.37 |
| Malpractice RVU | 0.11 | 0.11 |
| Total RVU | 3.71 | 2.18 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 99383
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $135.9 | $75.43 | $129.27 - $156.51 | 29 |
| Florida | $127.61 | $76.33 | $122.97 - $132.14 | 3 |
| Georgia | $121.81 | $73.05 | $117.77 - $125.84 | 2 |
| Illinois | $125.32 | $75.94 | $120.46 - $129.39 | 4 |
| Michigan | $121.55 | $73.56 | $118.87 - $124.22 | 2 |
| North Carolina | $118.34 | $70.66 | $118.34 - $118.34 | 1 |
| New York | $135.27 | $78.25 | $119.65 - $142.69 | 5 |
| Ohio | $118.43 | $71.77 | $118.43 - $118.43 | 1 |
| Pennsylvania | $123.38 | $73.32 | $118.51 - $128.25 | 2 |
| Texas | $122.98 | $72.67 | $117.94 - $127.29 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 99383
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 99383 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0359T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0360T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0361T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0362T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0363T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0364T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0365T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0366T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0367T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0368T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 99383
What does CPT code 99383 mean? +
CPT code 99383 represents: Prev visit new age 5-11. It's in the E/M category with a global period of XXX.
What is the Medicare reimbursement for CPT 99383? +
The 2026 Medicare national average non-facility payment for CPT 99383 is $127.32. Rates range from $113.19 to $156.51 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 99383? +
E/M codes commonly use modifier 25 (significant separately identifiable E/M on same day as a procedure), 57 (decision for major surgery), 24 (unrelated E/M during global period), 95 (synchronous audio+video telehealth), 93 (audio-only telehealth), and AI (principal physician of record on admission). Surgical modifiers like 50, 51, 59 do not apply to E/M.
What bundling edits apply to CPT 99383? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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