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

Alcohol Misuse Screening & Counseling

Guidelines for Alcohol Misuse Screening & Counseling

Annual Wellness Visit

Guidelines for Annual Wellness Visits

Bone Mass Measurements

Guidelines for Bone Mass Measurements

Cardiovascular Disease Screening Tests

Guidelines for Cardiovascular Disease Screening Tests

Colorectal Cancer Screening

Guidelines for Colorectal Cancer Screenings

Counseling to Prevent Tobacco Use

Guidelines for Counseling to Prevent Tobacco Use

Depression Screening

Guidelines for Depression Screenings

Diabetes Screening

Guidelines for Diabetes Screenings

Diabetes Self-Management Training

Guidelines for Diabetes Self-Management Training

Glaucoma Screening

Guidelines for Glaucoma Screenings

Hepatitis B Virus Screening

Guidelines for Hepatitis B Virus Screening

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

IBT for Obesity

Intensive Behavioral Therapy for Obesity

IBT for Cardiovascular Disease

Guidelines for Intensive Behavioral Therapy for Cardiovascular Disease

Influenza Virus Vaccine & Administration

Guidelines for Influenza Virus Vaccine & Administration

Initial Preventive Physical Examination

Guidelines for Initial Preventive Physical Examination

Lung Cancer Screening

Guidelines for Lung Cancer Screenings

Medical Nutrition Therapy

Guidelines for Medical Nutrition Therapy

Medicare Diabetes Prevention Program

Medicare Diabetes Prevention Program Expanded Model

Pneumococcal Vaccine & Administration

Guidelines for Pneumococcal Vaccine & Administration

Prolonged Preventive Services

Guidelines for Prolonged Preventive Services

Prostate Cancer Screening

Guidelines for Prostate Cancer Screenings

Screening for Cervical Cancer

Guidelines for Screening for Cervical Cancer

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 Pelvic Examination

Guidelines for Screening Pelvic Examination

Ultrasound Screening for AAA

Guidelines for Ultrasound Screening for Abdominal Aortic Aneurysm

Additional Links and Resources

Preventive and Screening Services

Ch. 18 Medicare Claims Processing Manual

Commonly Administered Pediatric Vaccines

American Academy of Pediatrics

Code Sets

CVX Vaccines Codes

CVX Vaccines Codes

Select the title to see a summary and a link to the full article.

Vaccine Administration - When The Right Vaccine Code is Not Enough

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Understanding how to apply immunization administration codes properly will support correct reimbursement for vaccinations. Reporting the right vaccine code alone is not enough to guarantee proper billing. The majority of the time, providers can charge for the vaccine/product as well as the administration of the vaccine; always consult your payer ...

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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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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: 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: 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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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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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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