Pediatrics ICD-10 Codes & CPT Codes

Pediatric coding spans well-child visits, acute illnesses, vaccinations, developmental screenings, and chronic condition management from newborn through adolescence. This page covers the most-used ICD-10-CM and CPT codes for pediatric practices in the United States.

FY 2026 ICD-10-CM (CMS) · CPT codes updated annually · All codes verified billable · Last verified: June 2026

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Top ICD-10 Codes for Pediatrics

ICD-10 Code Description Billable
Z00.129 Encounter for routine child health examination without abnormal findings, unspecified age ✓
J06.9 Acute upper respiratory infection, unspecified ✓
J00 Acute nasopharyngitis (common cold) ✓
H66.90 Otitis media, unspecified, unspecified ear ✓
J02.9 Acute pharyngitis, unspecified ✓
Z23 Encounter for immunization ✓
F90.0 ADHD, predominantly inattentive type ✓
F90.2 ADHD, combined type ✓
J45.40 Moderate persistent asthma, uncomplicated ✓
L20.9 Atopic dermatitis, unspecified ✓
Z00.110 Health examination for newborn under 8 days old ✓
R68.11 Excessive crying of infant (baby) ✓
F84.0 Autistic disorder ✓
G40.909 Epilepsy, unspecified, not intractable, without status epilepticus ✓
A09 Infectious gastroenteritis and colitis, unspecified ✓
Z00.121 Encounter for routine child health examination with abnormal findings ✓
J45.20 Mild intermittent asthma, uncomplicated ✓
J45.30 Mild persistent asthma, uncomplicated ✓
J45.50 Severe persistent asthma, uncomplicated ✓
L20.81 Atopic neurodermatitis ✓
F41.9 Anxiety disorder, unspecified ✓
F32.9 Major depressive disorder, single episode, unspecified ✓
Z13.88 Encounter for screening for disorder due to exposure to contaminants ✓
R62.50 Unspecified lack of expected normal physiological development in childhood ✓
Z00.00 Encounter for general adult medical examination without abnormal findings ✓
K21.0 Gastro-esophageal reflux disease with esophagitis ✓
K92.1 Melena ✓
B34.9 Viral infection, unspecified ✓
J20.9 Acute bronchitis, unspecified ✓
J11.1 Influenza due to unidentified influenza virus with other respiratory manifestations ✓
N39.0 Urinary tract infection, site not specified ✓
L70.0 Acne vulgaris ✓
G43.909 Migraine, unspecified, not intractable, without status migrainosus ✓
F93.0 Separation anxiety disorder of childhood ✓
F98.0 Enuresis not due to a substance or known physiological condition ✓
H10.9 Unspecified conjunctivitis ✓
J32.9 Chronic sinusitis, unspecified ✓
R50.9 Fever, unspecified ✓
Z71.3 Dietary counseling and surveillance ✓
F80.9 Developmental disorder of speech and language, unspecified ✓
Z00.01 Encounter for general adult medical examination with abnormal findings ✓
J18.9 Pneumonia, unspecified organism ✓
B06.9 Rubella without complication ✓
B05.9 Measles without complication ✓
B26.9 Mumps without complication ✓
L21.0 Seborrhea capitis ✓
K59.00 Constipation, unspecified ✓
R10.9 Unspecified abdominal pain ✓
H65.90 Unspecified nonsuppurative otitis media, unspecified ear ✓
J35.01 Chronic tonsillitis ✓
J30.9 Allergic rhinitis, unspecified ✓
Z00.111 Newborn health examination, under 8 days old, with abnormal findings ✓
R63.3 Feeding difficulties ✓
E11.9 Type 2 diabetes mellitus without complications ✓
E66.01 Morbid (severe) obesity due to excess calories ✓
F40.10 Social phobia, unspecified ✓
F43.10 Post-traumatic stress disorder, unspecified ✓
S00.01XA Unspecified superficial injury of scalp, initial encounter ✓
T14.90 Injury, unspecified, initial encounter ✓
Z13.6 Encounter for screening for cardiovascular disorders ✓
Z13.220 Encounter for screening for lipoid disorders ✓
G47.30 Sleep apnea, unspecified ✓
R55 Syncope and collapse ✓
F50.00 Anorexia nervosa, unspecified ✓
F50.2 Bulimia nervosa ✓

Source: CMS ICD-10-CM Official Code Set FY 2026

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Common CPT Codes for Pediatrics Billing

CPT Code Description Medicare Rate* Common Modifiers
99391 Periodic comprehensive preventive medicine, established patient, infant (age younger than 1 year) ~$81 -25, -33
99392 Periodic comprehensive preventive medicine, established patient, age 1-4 years ~$88 -25, -33
99393 Periodic comprehensive preventive medicine, established patient, age 5-11 years ~$91 -25, -33
99394 Periodic comprehensive preventive medicine, established patient, age 12-17 years ~$95 -25, -33
99213 Office or other outpatient visit, established patient, low medical decision complexity ~$92 -25, -57, -GT
99214 Office or other outpatient visit, established patient, moderate medical decision complexity ~$134 -25, -57, -GT
99203 Office or other outpatient visit, new patient, low medical decision complexity ~$111 -25, -57
99204 Office or other outpatient visit, new patient, moderate medical decision complexity ~$167 -25, -57
90686 Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, intramuscular ~$27 -SL, -QS
96110 Developmental screening with scoring and documentation, per standardized instrument ~$29 -25, -59
96161 Administration of caregiver-focused health risk assessment instrument with scoring and documentation ~$19 -25
99381 Preventive medicine, new patient, infant (age younger than 1 year) ~$90 -25, -33
99382 Preventive medicine, new patient, age 1-4 years ~$97 -25, -33
99383 Preventive medicine, new patient, age 5-11 years ~$100 -25, -33
90460 Immunization administration through 18 years of age via any route of administration, first vaccine/toxoid component ~$24 -25
90461 Immunization administration through 18 years of age, each additional vaccine/toxoid component ~$14 -25
99406 Smoking and tobacco use cessation counseling visit, intermediate, 3-10 minutes ~$15 -25
93000 Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report ~$23 -26, -TC

*Approximate 2025 CMS national non-facility rate. Rates vary by geography, setting, and payer contract. Refer to the CMS Physician Fee Schedule for official rates.

Top Denial Reasons for Pediatrics Claims

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Well-Child Visit Billed Same Day as Sick Visit Without Modifier -25

Payers routinely deny a separate E&M service billed on the same date as a preventive visit unless modifier -25 is appended to indicate a separately identifiable, medically necessary service. Always attach -25 to the sick-visit code and document the distinct chief complaint and medical decision-making in the encounter note.

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Vaccine Administration Denied Due to Missing or Incorrect Vaccine Code Linkage

Claims for immunization administration (90460/90461) are denied when the corresponding vaccine product code (e.g., 90686) is not billed on the same claim, or when an incorrect vaccine code is paired with the administration code. Ensure each administration code is linked to the exact product code administered and that the units for 90461 reflect each additional component correctly.

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Developmental Screening (96110) Denied for Insufficient Documentation

Payers deny 96110 when the claim lacks evidence that a standardized, validated screening instrument (e.g., M-CHAT-R, ASQ) was used and that scoring with clinician interpretation was documented in the medical record. Attach the completed instrument or note the tool name, score, and any follow-up action taken.

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ADHD Management Claims Denied for Missing Diagnosis-to-Procedure Linkage

Office visits coded for ADHD management (F90.0, F90.2) are denied when documentation does not support the level of MDM billed or when the claim lacks a qualifying diagnosis pointer to the E&M code. Ensure the encounter note captures the number and complexity of problems addressed, data reviewed, and risk of treatment to support the selected E&M level.

Pediatrics Billing & Coding Tips

  • Use age-specific well-child CPT codes (99381–99385 new, 99391–99395 established) — billing the wrong age band triggers claim edits.
  • Z23 is the primary diagnosis for immunization-only visits; add the specific vaccine product codes from the 90xxx series.
  • ADHD coding requires specifying subtype: F90.0 (predominantly inattentive), F90.1 (predominantly hyperactive-impulsive), or F90.2 (combined).
  • Developmental screening (96110) can be billed in addition to a well-child E&M at the same visit without a modifier.

Frequently Asked Questions

What ICD-10 code is used for a well-child visit?

Z00.12x codes are used for routine child health examinations. Z00.129 is the unspecified age version. Z00.121 is for children with abnormal findings. Select the appropriate code based on age and findings documented.

What CPT code is used for a 4-year-old well visit?

99392 covers preventive medicine for established patients aged 1–4 years. For a new patient at the same age, use 99382. Both include a comprehensive history, exam, and counseling.

Can I bill for developmental screening separately?

Yes. 96110 (developmental screening) and 96127 (behavioral/emotional screening) can both be billed on the same day as a preventive E&M without a modifier. Each must have a documented instrument, score, and clinician review.

What is the ADHD code for combined type?

F90.2 is the ICD-10 code for ADHD, combined presentation (formerly combined type in DSM-IV). It requires documentation of both inattentive and hyperactive-impulsive symptoms meeting DSM-5 criteria for at least 6 months.

How does OmniMD support pediatric practices?

OmniMD’s Pediatrics EHR includes growth chart tracking, immunization scheduling aligned with ACIP guidelines, and age-appropriate developmental screening tools integrated directly into the well-child visit workflow.

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