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Preventive Medicine

This is an educational tool, not meant to be viewed as coding or billing guidelines.

Preventive Medicine Coding and Billing Info

Telehealth applicable codes will be indicated with a phone icon. 

Click on the topic you’re interested in below to view the information for it. You can also scroll down to review all topics. To see published recommendations according to population/grade per U.S. Preventive Services Task Force click here

Preventive Medicine Topics

General Codes

Guidelines for General Procedures

Alcohol Misuse Screening & Counseling

Guidelines for Alcohol Misuse Screening & Counseling

Screening for Anemia

Guidelines for Screening for Anemia

Annual Wellness Visit

Guidelines for Annual Wellness Visits

Bone Mass Measurements

Guidelines for Bone Mass Measurements

Breast Cancer Genetic Screening

Guidelines for Breast Cancer Genetic Screenings

Breastfeeding Supplies

Guidelines for Breast Feeding Supplies

Cardiovascular Disease Screening Tests

Guidelines for Cardiovascular Disease Screening Tests

Cervical Dysplasia Screening

Guidelines for Cervical Dysplasia Screenings

Colorectal Cancer Screening

Guidelines for Colorectal Cancer Screenings

Contraceptive Methods

Guidelines for Contraceptive Methods

Counseling to Prevent Tobacco Use

Guidelines for Counseling to Prevent Tobacco Use

Dental Caries in Children

Guidelines for Dental Caries in Children

Depression Screening

Guidelines for Depression Screenings

Diabetes Screening

Guidelines for Diabetes Screenings

Diabetes Self-Management Training

Guidelines for Diabetes Self-Management Training

Therapy for Fall Prevention

Guidelines for Therapy for Fall Prevention

Glaucoma Screening

Guidelines for Glaucoma Screenings

HBV Vaccine & Administration

Guidelines for Hepatitis B Virus Vaccine & Administration

Hepatitis C Virus Screening

Guidelines for Hepatitis C Virus Screenings

HIV Screening

Guidelines for Human Immunodeficiency Virus Screenings

HPV Vaccine and Screening

Guidelines for Human Papilomavirus Vaccine and Screenings

Influenza Virus Vaccine & Administration

Guidelines for Influenza Virus Vaccine & Administration

Initial Preventive Physical Examination

Guidelines for Initial Preventive Physical Examination

MNT and CVD/Obesity Prevention

Guidelines for Medical Nutrition Therapy and Cardiovascular Disease /Obesity Prevention

Lung Cancer Screening

Guidelines for Lung Cancer Screenings

Newborn Screenings/Tests

Guidelines for Newborn Screenings/Tests

Pneumococcal Vaccine & Administration

Guidelines for Pneumococcal Vaccine & Administration

Prostate Cancer Screening

Guidelines for Prostate Cancer Screenings

Screening for STIs and HIBC to Prevent STIs

Guidelines for Screening for STIs and High Intensity Behavioral Counseling to Prevent STIs

Screening Mammography

Guidelines for Screening Mammographies

Screening Pap Tests

Guidelines for Screening Pap Tests

Screening Gynecological Examination

Guidelines for Screening Gynecological Examinations

Ultrasound Screening for AAA

Guidelines for Ultrasound Screening for Abdominal Aortic Aneurysm

Visual Acuity Screening

Guidelines for Visual Acuity Screenings

Modifier 33

Guidelines for Modifier 33

Links and Resources/References

Additional Links and Resources & References

Preventive Medicine Articles

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CMS: Medicare Diabetes Prevention Program Expanded Model

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CMS announces the Medicare Diabetes prevention program is now a new covered service. Per a recent MLN news release. Medicare Beneficiaries will be notified in 2019 in a Medicare handout. Diabetes affects more than 25 percent of Americans aged 65 or older, and its prevalence is projected to increase approximately...

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Understanding the Level of Preventative Services (Grades and Suggestions)

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It is essential for providers, clinicians, and other users to understand the importance of providing preventative services.  The U.S. Preventative Services Task Force (USPSTF) has recommendations and has applied Grade Definitions as a suggested resource to imply the significance and strength of preventative services.  The following definitions apply to recommendations ...

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New on our TOPICS Page - "Preventive Medicine Coding and Billing Information"

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There is a lot of information available for you to utilize on our Topics pages. We have recently added a Preventative Medicine TOPICS page (under subjects), as per customers' request, for searching Preventative Codes. We're made it easy to locate services required under the Affordable Care Act for reporting preventive services. ...

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AMA vs Medicare rules and the use of the PT modifier

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Be sure to review the specific payer policy you are submitting claims to. Medicare’s policy requires the use of a different code when a screening colonoscopy becomes a diagnostic procedure requiring you to bill with CPT code 00811 when treating a Medicare Beneficiary. The use of the PT modifier is ...

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Preventive Medicine: General Procedures

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Preventive Medicine Topics Page General Procedures Procedure Codes 36415: Collection of venous blood by venipuncture 90471: Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 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 ...

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Preventive Medicine: Links and Resources

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Back to Topic Page References Kaiser Permanentehttps://provider.ghc.org/open/coverageAndEligibility/groupHealthPlans/preventive-services-guidelines.pdf Medicare Learning Networkhttps://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/Downloads/MPS-QuickReferenceChart-1TextOnlywithICD9.pdf AAFP - ICD-10 Simplifies Preventive Care Coding, Sort Of - Cindy Hugheshttps://www.aafp.org/fpm/2014/0700/oa1.html List of ACA Preventive Services and CPT Codes - STDshttp://stdtac.org/wp-content/uploads/2014/06/List-of-ACA-Preventative-Services-and-CPT-Codes-_STDTAC.pdf Additional Links and Resources ACA guidelines as per healthcare.govhttps://www.healthcare.gov/coverage/preventive-care-benefits/ Preventive Medicine Listhttps://www1.ghc.org/static/pdf/public/formulary/aca-list.pdf ...

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Preventive Medicine: Alcohol Misuse Screening & Counseling

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Preventive Medicine Topics Page // Alcohol Misuse Screening and Counseling Procedure Codes G0442: Annual alcohol misuse screening, 15 minutes G0443: Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes 99408: Alcohol and/or substance (other than tobacco) abuse structured screening (eg, AUDIT, DAST), and brief intervention (SBI) services; 15 to ...

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Preventive Medicine: Screening for Anemia

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Preventive Medicine Topics Page Screening for Anemia Procedure Codes 85004: Blood count; automated differential WBC count 85014: Blood count; hematocrit (Hct) 85013: Blood count; spun microhematocrit 85018: Blood count; hemoglobin (Hgb) 80055: Obstetric panel ICD-10-CM 85004, 85013-85014, 85018: Z00.121, Z00.129, Z00.110, Z00.111, Z13.0 80055, 85004, 85014, 85013: O00.0-O03.9, O08.0-O08.9, O09.00-O09.93, O10.011-O16.9, ...

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Preventive Medicine: Annual Wellness Visit

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Preventive Medicine Topics Page Annual Wellness Visit Procedure Codes G0438: Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit G0439: Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit 99385: Initial comprehensive preventive medicine evaluation and management of an individual including ...

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Preventive Medicine: Bone Mass Measurements

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Preventive Medicine Topics Page Bone Mass Measurements Procedure Codes G0130: Single energy x-ray absorptiometry (sexa) bone density study, one or more sites; appendicular skeleton (peripheral) (eg, radius, wrist, heel) 76977: Ultrasound bone density measurement and interpretation, peripheral site(s), any method 77078: Computed tomography, bone mineral density study, 1 or more ...

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Preventive Medicine: Breast Cancer Genetic Screening

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Preventive Medicine Topics Page Breast Cancer Genetic Screening Procedure Codes 81211: BRCA1, BRCA2 (breast cancer 1 and 2) (eg, hereditary breast and ovarian cancer) gene analysis; full sequence analysis and common duplication/deletion variants in BRCA1 (ie, exon 13 del 3.835kb, exon 13 dup 6kb, exon 14-20 del 26kb, exon 22 ...

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Preventive Medicine: Breastfeeding Supplies

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Preventive Medicine Topics Page Breastfeeding Supplies Procedure Codes A4286: Locking ring for breast pump, replacement E0602: Breast pump, manual, any type E0603: Breast pump, electric (ac and/or dc), any type E0604: Breast pump, hospital grade, electric (ac and / or dc), any type S9443: Lactation classes, non-physician provider, per session ICD-10-CM ...

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Preventive Medicine: Cardiovascular Disease Screening Tests

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Preventive Medicine Topics Page Cardiovascular Disease Screening Tests Procedure Codes 80061: Lipid panel. This panel must include the following: Cholesterol, serum, total Lipoprotein, direct measurement, high density cholesterol (HDL cholesterol) Triglycerides 82465: Cholesterol, serum, total 83718: Lipoprotein, direct measurement, high density cholesterol (HDL cholesterol) 84478: Triglycerides 83721: Lipoprotein, direct measurement; LDL cholesterol 83719: Lipoprotein, ...

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Preventive Medicine: Cervical Dysplasia Screening

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Preventive Medicine Topics Page Cervical Dysplasia Screening Procedure Codes 88141: Cytopathology, cervical or vaginal (any reporting system), requiring interpretation by physician 88142: Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; manual screening under physician supervision 88143: Cytopathology, cervical or vaginal (any reporting system), collected ...

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Preventive Medicine: Colorectal Cancer Screening

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Preventive Medicine Topics Page Colorectal Cancer Screening Procedure Codes G0104: Colorectal cancer screening; flexible sigmoidoscopy G0105: Colorectal cancer screening; colonoscopy on individual at high risk G0106: Colorectal cancer screening; screening sigmoidoscopy, barium enema G0121: Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk G0122: Colorectal cancer screening; barium ...

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Preventive Medicine: Contraceptive Methods

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Preventive Medicine Topics Page Contraceptive Methods Procedure Codes A4261: Cervical cap for contraceptive use A4266: Diaphragm for contraceptive use A4264: Permanent implantable contraceptive intratubal occlusion device(s) and delivery system J7300: Intrauterine copper contraceptive J7301: Levonorgestrel-releasing intrauterine contraceptive system (skyla), 13.5 mg J7303: Contraceptive supply, hormone containing vaginal ring, each J7304: ...

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Preventive Medicine: Counseling to Prevent Tobacco Use

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Preventive Medicine Topics Page Counseling to Prevent Tobacco Use Procedure Codes 99406: Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes 99407: Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes ICD-10-CM 99406-99407: No specific diagnoses Frequency 99406-99407: 2 attempts a year, ...

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Preventive Medicine: Depression Screening

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Preventive Medicine Topics Page Depression Screening Procedure Codes G0444: Annual depression screening, 15 minutes 96127: Brief emotional/behavioral assessment (eg, depression inventory, attention-deficit/hyperactivity disorder [ADHD] scale), with scoring and documentation, per standardized instrument ICD-10-CM G0444, 96127: No specific diagnoses Frequency G0444:Once annually 96127: No specific frequency guidelines Additional Information 96127 Only covered for ages ...

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Preventive Medicine: Diabetes Screening

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Preventive Medicine Topics Page Diabetes Screening Procedure Codes 82947: Glucose; quantitative, blood (except reagent strip) 82948: Glucose; blood, reagent strip 82950: Glucose; post glucose dose (includes glucose) 82951: Glucose; tolerance test (GTT), 3 specimens (includes glucose) 82952: Glucose; tolerance test, each additional beyond 3 specimens (List separately in addition to ...

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Preventive Medicine: Diabetes Self-Management Training

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Preventive Medicine Topics Page Diabetes Self-Management Training Procedure Codes G0108: DSMT, individual, per 30 minutes G0109: GDSMT, group (2 or more), per 30 minutes ICD-10-CM G0108-G0109: Contact payer for more specific guidelines Frequency G0108-G0109 Initial year: Up to 10 hours of initial training within a continuous 12-month period Subsequent years: Up to 2 ...

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Preventive Medicine: Therapy for Fall Prevention

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Preventive Medicine Topics Page Therapy for Fall Prevention Procedure Codes 97110: Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility 97112: Therapeutic procedure, 1 or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, ...

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Preventive Medicine: Glaucoma Screening

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Preventive Medicine Topics Page Glaucoma Screening Procedure Codes G0117: Glaucoma screening for high risk patients furnished by an optometrist or ophthalmologist G0118: Glaucoma screening for high risk patient furnished under the direct supervision of an optometrist or ophthalmologist ICD-10-CM G0117-G0118: Z13.5 Frequency G0117-G0118: Once a year Additional information G0117-G0118 Coverage as is indicated with ...

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Preventive Medicine: Hepatitis B Virus (HBV) Vaccine and Administration

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Preventive Medicine Topics Page Hepatitis B Virus (HBV) Vaccine and Administration Procedure Codes G0010: Administration of hepatitis b vaccine 90739: Hepatitis B vaccine (HepB), adult dosage, 2 dose schedule, for intramuscular use 90740: Hepatitis B vaccine (HepB), dialysis or immunosuppressed patient dosage, 3 dose schedule, for intramuscular use 90743: Hepatitis ...

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Preventive Medicine: Hepatitis C Virus (HCV) Screening

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Preventive Medicine Topics Page Hepatitis C Virus (HCV) Screening Procedure Codes G0472: Hepatitis c antibody screening, for individual at high risk and other covered indication(s) 87522: Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, quantification, includes reverse transcription when performed 86804: Hepatitis C antibody; confirmatory test (eg, ...

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Preventive Medicine: Human Papilomavirus (HPV) Vaccine and Screening

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Preventive Medicine Topics Page Human Papilomavirus (HPV) Vaccine and Screening Procedure Codes 87623: Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), low-risk types (eg, 6, 11, 42, 43, 44) 87624: Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), high-risk types (eg, 16, 18, ...

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Preventive Medicine: Influenza Virus Vaccine and Administration

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Preventive Medicine Topics Page Influenza Virus Vaccine and Administration Procedure Codes Q2034: Influenza virus vaccine, split virus, for intramuscular use (agriflu) Q2035: Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (afluria) Q2036: Influenza virus vaccine, split virus, when administered to individuals ...

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Preventive Medicine: Initial Preventive Physical Examination

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Preventive Medicine Topics Page Initial Preventive Physical Examination (Medicare Only) Procedure Codes G0402: Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment G0403: Electrocardiogram, routine ecg with 12 leads; performed as a screening for the initial preventive physical examination with interpretation ...

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Preventive Medicine: Medical Nutrition Therapy and Cardiovascular Disease (CVD)/Obesity Prevention

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Preventive Medicine Topics Page Medical Nutrition Therapy and Cardiovascular Disease (CVD)/Obesity Prevention Procedure Codes G0270: Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face to face with the patient, ...

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Preventive Medicine: Lung Cancer Screening

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Preventive Medicine Topics Page Lung Cancer Screening Procedure Codes G0296: Counseling visit to discuss need for lung cancer screening (ldct) using low dose ct scan (service is for eligibility determination and shared decision making) G0297: Low dose ct scan (ldct) for lung cancer screening S8092: Electron beam computed tomography (also ...

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Preventive Medicine: Newborn Screenings/Tests

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Preventive Medicine Topics Page Newborn Screenings/Tests Procedure Codes 82775: Galactose-1-phosphate uridyl transferase; quantitative 83498: Hydroxyprogesterone, 17-d 82017: Acylcarnitines; quantitative, each specimen 82136: Amino acids, 2 to 5 amino acids, quantitative, each specimen 82261: Biotinidase, each specimen 83020: Hemoglobin fractionation and quantitation; electrophoresis (eg, A2, S, C, and/or F) 83021: Hemoglobin ...

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Preventive Medicine: Pneumococcal Vaccine and Administration

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Preventive Medicine Topics Page Pneumococcal Vaccine and Administration Procedure Codes G0009: Administration of pneumococcal vaccine 90670: Pneumococcal conjugate vaccine, 13 valent (PCV13), for intramuscular use 90732: Pneumococcal polysaccharide vaccine, 23-valent (PPSV23), adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use ICD-10-CM G0009, ...

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Preventive Medicine: Prostate Cancer Screening

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Preventive Medicine Topics Page Prostate Cancer Screening Procedure Codes G0102: Prostate cancer screening; digital rectal examination G0103: Prostate cancer screening; prostate specific antigen test (PSA) ICD-10-CM G0102-G0103: Z12.5 Frequency G0102-G0103: Once annually Additional Information G0102-G0103 Only for males aged 50 and older G0102 Copayment and deductible may apply, consult your payer Find-A-Code™ - Preventive Services - ...

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Preventive Medicine: Screening for STIs & HIBC to Prevent STIs

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Preventive Medicine Topics Page Screening for STIs and High Intensity Behavioral Counseling (HIBC) to Prevent STIs Procedure Codes 86592: Syphilis test, non-treponemal antibody; qualitative (eg, VDRL, RPR, ART) 86593: Syphilis test, non-treponemal antibody; quantitative 86631: Antibody; Chlamydia 86632: Antibody; Chlamydia, IgM 86780: Antibody; Treponema pallidum 87110: Culture, chlamydia, any source ...

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Preventive Medicine: Screening Mammography

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Preventive Medicine Topics Page Screening Mammography Procedure Codes 77052: Computer-aided detection (computer algorithm analysis of digital image data for lesion detection) with further physician review for interpretation, with or without digitization of film radiographic images; screening mammography (list separately in addition to code for primary procedure) 77057: Screening mammography, bilateral ...

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Preventive Medicine: Screening Pap Tests

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Preventive Medicine Topics Page Screening Pap Tests Procedure Codes G0123: Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision G0124: Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, requiring interpretation ...

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Preventive Medicine: Screening Gynecological Examination

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Preventive Medicine Topics Page Screening Gynecological Examination Procedure Codes G0101: Cervical or vaginal cancer screening; pelvic and clinical breast examination S0610: Annual gynecological examination; clinical breast examination without pelvic evaluation S0612: Annual gynecological examination, established patient S0613: Annual gynecological examination, new patient ICD-10-CM G0101:Low risk patients - Z01.411, Z01.419, Z12.4, Z12.72, ...

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Preventive Medicine: Ultrasound Screening for Abdominal Aortic Aneurysm (AAA)

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Preventive Medicine Topics Page Ultrasound Screening for Abdominal Aortic Aneurysm (AAA) Procedure Codes 76706: Ultrasound, abdominal aorta, real time with image documentation, screening study for abdominal aortic aneurysm (AAA) 76770: Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real time with image documentation; complete 76775: Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real ...

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Preventive Medicine: Screening Children for Visual Acuity

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Preventive Medicine Topics Page Screening Children for Visual Acuity Procedure Codes 99173: Screening test of visual acuity, quantitative, bilateral ICD-10-CM 99173: Z00.121, Z00.129, Z00.100, Z00.101 Frequency 99173: No specific frequency guidelines Additional Information 99173 Not covered by Medicare for preventative care Some policies will only cover as preventive for children, consult your payer Find-A-Code™ - Preventive ...

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Preventive Medicine: Use of Modifier 33

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Preventive Medicine Topics Page The Use of Modifier 33 Modifier 33 is used to indicate Preventive Services to report quality metrics and is informational only, it has no impact on reimbursement. Modifier 33 should be reported only to private payers, Medicare and Medicaid do not recognize this modifier. ...

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Preventive Medicine: Dental Caries in Children

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Preventive Medicine Topics Page Dental Caries in Children Procedure Codes 99188: Application of topical fluoride varnish by a physician or other qualified health care professional ICD-10-CM 99188: No specific diagnoses Frequency 99188: No specific frequency guidelines Additional Information 99188 Covered for children from birth until their seventh birthday Find-A-Code™ - Preventive Services - The information ...

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How to Code Screening and Diagnostic Colonoscopy

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The following information is from BC Advantage. Colonoscopy is a common procedure performed byGastroenterologists. CPT defines a colonoscopy examination as "the examination of the entire colon, from the rectum to the cecum or colon-small intestine anastomosis, and may include examination of the terminal ileum or small intestine proximal to an anastomosis" ...

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Preventive Medicine with a New Patient

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When coding for preventive care, be sure to use the correct encounter code with the procedure as well as the appropriate modifier if required. New Patient:  A patient that has not received any professional services i.e., E&M  or any other face to face service from the physician or group within the ...

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Preventive Services: Human Immunodeficiency Virus (HIV) Screening

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The following information from the Medicare Learning Network provides guidance on Human Immunodeficiency Virus (HIV) Screening....

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Preventive Services: Lung Cancer Counseling and Annual Screening for Lung Cancer With LDCT

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The following information from the Medicare Learning Network provides guidance on Lung Cancer Screening Counseling, and Annual Screening for Lung Cancer With Low Dose Computed Tomography (LDCT)....

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Preventive Services: Prostate Cancer Screening

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The following information from the Medicare Learning Network provides guidance on Prostate Cancer Screening....

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Preventive Services: Screening for Cervical Cancer with Human Papillomavirus (HPV) Tests

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The following information from the Medicare Learning Network provides guidance on Screening for Cervical Cancer with Human Papillomavirus (HPV) Tests....

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Preventive Services: Screening for STIs and High Intensity Behavioral Counseling (HIBC) to Prevent STIs

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The following information from the Medicare Learning Network provides guidance on Screening for Sexually Transmitted Infections (STIs) and High Intensity Behavioral Counseling (HIBC) to Prevent STIs.....

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Preventive Services: Screening Pap Tests

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The following information from the Medicare Learning Network provides guidance on Screening Pap Tests....

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Preventive Services: Screening Pelvic Examinations

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The following information from the Medicare Learning Network provides guidance on Screening Pelvic Examinations (includes a clinical breast examination)....

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Preventive Medicine Webinars

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Proper Coding and Billing for Drugs, Biologicals and Injections

Proper Coding and Billing for Drugs, Biologicals and Injections

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Plan networks and government plans are required to cover preventive services as required by the Affordable Care Act (ACA) at no cost to the patient. This covers numerous screenings, counseling and well visits to prevent illness, disease and health problems. Services are based on age, gender, and other health factors. This does not include diagnostic testing as this is not considered preventive. Preventive services must be performed by a covered provider, in-network and may be used to develop a wellness plan to keep the patient healthy.

This page was created from a need to have all of the information in one place to accommodate Payers, Providers, Researchers, and others, suggestions and feedback are always welcome, please send it to us at Support@Findacode.com. The information covered on this page is informational only and not meant to be all-inclusive, always verify coverage with your payer.

For more information about the Affordable Care Act visit HHS.gov


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