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Preventive Medicine
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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 TopicsAlcohol Misuse Screening & Counseling Guidelines for Alcohol Misuse Screening & Counseling Annual Wellness Visit Guidelines for Annual Wellness Visits Bone Mass MeasurementsGuidelines for Bone Mass Measurements Cardiovascular Disease Screening TestsGuidelines for Cardiovascular Disease Screening Tests Colorectal Cancer ScreeningGuidelines for Colorectal Cancer Screenings Counseling to Prevent Tobacco Use Guidelines for Counseling to Prevent Tobacco Use Depression Screening Guidelines for Depression Screenings Diabetes ScreeningGuidelines for Diabetes Screenings Diabetes Self-Management Training Guidelines for Diabetes Self-Management Training Glaucoma ScreeningGuidelines for Glaucoma Screenings Hepatitis B Virus ScreeningGuidelines for Hepatitis B Virus Screening HBV Vaccine & AdministrationGuidelines for Hepatitis B Virus Vaccine & Administration Hepatitis C Virus ScreeningGuidelines for Hepatitis C Virus Screenings HIV ScreeningGuidelines 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 & AdministrationGuidelines for Influenza Virus Vaccine & Administration Initial Preventive Physical ExaminationGuidelines for Initial Preventive Physical Examination Lung Cancer ScreeningGuidelines for Lung Cancer Screenings Medical Nutrition Therapy Guidelines for Medical Nutrition Therapy Medicare Diabetes Prevention ProgramMedicare Diabetes Prevention Program Expanded Model Pneumococcal Vaccine & AdministrationGuidelines for Pneumococcal Vaccine & Administration Prolonged Preventive Services Guidelines for Prolonged Preventive Services Prostate Cancer ScreeningGuidelines for Prostate Cancer Screenings Screening for Cervical CancerGuidelines for Screening for Cervical Cancer Screening for STIs and HIBC to Prevent STIsGuidelines for Screening for STIs and High Intensity Behavioral Counseling to Prevent STIs Screening MammographyGuidelines for Screening Mammographies Screening Pap TestsGuidelines for Screening Pap Tests Screening Pelvic ExaminationGuidelines for Screening Pelvic Examination Ultrasound Screening for AAAGuidelines for Ultrasound Screening for Abdominal Aortic Aneurysm Code SetsCVX Vaccines CodesCVX Vaccines Codes Additional Links and ResourcesPreventive and Screening ServicesCh. 18 Medicare Claims Processing Manual Commonly Administered Pediatric VaccinesAmerican Academy of Pediatrics CMS - Seasonal Influenza Vaccines PricingCMS - Seasonal Influenza Vaccines Pricing Recommendations for Preventive MedicineHRSA Recommended Preventive ServicesBright Futures Initiative HRSA Recommended Preventive ServicesRecommended Uniform Screening Panel HRSA Recommended Preventive ServicesWomen’s Preventive Services Guidelines US Preventive Services Task forceUS Preventive Services Task force Recommendations ACIP RecommendationsACIP Recommendations Select the title to see a summary and a link to the full article. May 26th, 2022 Preventive Medicine Versus E&M Codes: The Same-Day Coding DilemmaBy Terry Fletcher, BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMSCS, CMCS, ACS-CA, SCP-CA, QMGC, QMCRC | Published May 26th, 2022 Choosing a proper office visit code can become confusing unless one understands the rules separating preventive medicine and evaluation and management (E&M) coding. Problem-oriented E&M services, office, and other outpatient visit codes 99202-99215 (along with hospital, observation, and consultative encounters) are for patients who present with signs, symptoms,... April 26th, 2022 Preventive ServicesBy Shannon DeConda, CPC, CEMC, CEMA, CPMA, CRTT | Published April 26th, 2022 In Today’s Take, let’s discuss the difference between preventive care. You might be thinking this is “101”. But it really isn’t. Oftentimes, when conducting chart audits, we not only we see issues with a lack of documentation criteria, especially with Medicare preventive services, but we also see confusion regarding... September 30th, 2019 Vaccine Administration - When The Right Vaccine Code is Not EnoughBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published September 30th, 2019 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 ... February 12th, 2019 Coding Medicare Initial Preventive Physical Exams (IPPE)By | Published February 12th, 2019 The Medicare Initial Preventive Physical Exam (IPPE), also commonly referred to as the “Welcome to Medicare Physical”, may seem daunting to many, but when broken out to identify the requirements is fairly straightforward.
Purpose
An IPPE helps the Medicare beneficiary (the patient) get to know their healthcare provider at a time when they ... November 1st, 2018 CMS: Medicare Diabetes Prevention Program Expanded ModelBy Find-A-Code | Published November 1st, 2018 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... July 17th, 2018 Understanding the Level of Preventative Services (Grades and Suggestions)By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published July 17th, 2018 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 ... June 7th, 2018 New on our TOPICS Page - "Preventive Medicine Coding and Billing Information"By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 7th, 2018 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. ... May 22nd, 2018 AMA vs Medicare rules and the use of the PT modifierBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published May 22nd, 2018 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 ... May 9th, 2018 Preventive Medicine: General ProceduresBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update July 30th, 2018 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 ... May 9th, 2018 Preventive Medicine: Links and ResourcesBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update July 30th, 2018 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
... May 9th, 2018 Preventive Medicine: Alcohol Misuse Screening & CounselingBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update July 30th, 2018 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 ... May 9th, 2018 Preventive Medicine: Screening for AnemiaBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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, ... May 9th, 2018 Preventive Medicine: Annual Wellness VisitBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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 ... May 9th, 2018 Preventive Medicine: Bone Mass MeasurementsBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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 ... May 9th, 2018 Preventive Medicine: Breast Cancer Genetic ScreeningBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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 ... May 9th, 2018 Preventive Medicine: Breastfeeding SuppliesBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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 ... May 9th, 2018 Preventive Medicine: Cardiovascular Disease Screening TestsBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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, ... May 9th, 2018 Preventive Medicine: Cervical Dysplasia ScreeningBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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 ... May 9th, 2018 Preventive Medicine: Colorectal Cancer ScreeningBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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 ... May 9th, 2018 Preventive Medicine: Contraceptive MethodsBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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: ... May 9th, 2018 Preventive Medicine: Counseling to Prevent Tobacco UseBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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, ... May 9th, 2018 Preventive Medicine: Depression ScreeningBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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 ... May 9th, 2018 Preventive Medicine: Diabetes ScreeningBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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 ... May 9th, 2018 Preventive Medicine: Diabetes Self-Management TrainingBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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 ... May 9th, 2018 Preventive Medicine: Therapy for Fall PreventionBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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, ... May 9th, 2018 Preventive Medicine: Glaucoma ScreeningBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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 ... May 9th, 2018 Preventive Medicine: Hepatitis B Virus (HBV) Vaccine and AdministrationBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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 ... May 9th, 2018 Preventive Medicine: Hepatitis C Virus (HCV) ScreeningBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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, ... May 9th, 2018 Preventive Medicine: Human Immunodeficiency Virus (HIV) ScreeningBy Brandon Herman, QMC, QMCC, QMBHC, QMPM, QMPoC | Published May 9th, 2018 - Last Review/Update August 1st, 2018 Preventive Medicine Topics Page
Human Immunodeficiency Virus (HIV) Screening
Procedure Codes G0432: Infectious agent antibody detection by enzyme immunoassay (eia) technique, hiv-1 and/or hiv-2, screening G0433: Infectious agent antibody detection by enzyme-linked immunosorbent assay (elisa) technique, hiv-1 and/or hiv-2, screening G0435: Infectious agent antibody detection by rapid antibody test, hiv-1 ... May 9th, 2018 Preventive Medicine: Human Papilomavirus (HPV) Vaccine and ScreeningBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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, ... May 9th, 2018 Preventive Medicine: Influenza Virus Vaccine and AdministrationBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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 ... May 9th, 2018 Preventive Medicine: Initial Preventive Physical ExaminationBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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 ... May 9th, 2018 Preventive Medicine: Medical Nutrition Therapy and Cardiovascular Disease (CVD)/Obesity PreventionBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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, ... May 9th, 2018 Preventive Medicine: Lung Cancer ScreeningBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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 ... May 9th, 2018 Preventive Medicine: Newborn Screenings/TestsBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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 ... May 9th, 2018 Preventive Medicine: Pneumococcal Vaccine and AdministrationBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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, ... May 9th, 2018 Preventive Medicine: Prostate Cancer ScreeningBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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 - ... May 9th, 2018 Preventive Medicine: Screening for STIs & HIBC to Prevent STIsBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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 ... May 9th, 2018 Preventive Medicine: Screening MammographyBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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 ... May 9th, 2018 Preventive Medicine: Ultrasound Screening for Abdominal Aortic Aneurysm (AAA)By Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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 ... May 9th, 2018 Preventive Medicine: Screening Children for Visual AcuityBy Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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 ... May 9th, 2018 Preventive Medicine: Use of Modifier 33By Find-A-Code™ | Published May 9th, 2018 - Last Review/Update August 1st, 2018 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.
... May 9th, 2018 Preventive Medicine: Dental Caries in ChildrenBy Find-A-Code | Published May 9th, 2018 - Last Review/Update August 2nd, 2018 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 ... February 1st, 2018 How to Code Screening and Diagnostic ColonoscopyBy Natalie Tornese, CPC | Published February 1st, 2018 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" ... January 9th, 2018 Preventive Medicine with a New PatientBy Find-A-Code | Published January 9th, 2018 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 ... September 1st, 2017 Preventive Services: Alcohol Misuse Screening and CounselingBy Find-A-Code | Published September 1st, 2017 - Last Review/Update February 5th, 2018 The following information from the Medicare Learning Network (MLN) provides guidance on Alcohol Misuse Screening and Counseling....... September 1st, 2017 Preventive Services: Annual Wellness Visit (AWV)By Find-A-Code | Published September 1st, 2017 - Last Review/Update March 12th, 2018 The following information from the Medicare Learning Network provides guidance on Annual Wellness Visits (AWV) September 1st, 2017 Preventive Services: Cardiovascular Disease Screening TestsBy Find-A-Code | Published September 1st, 2017 - Last Review/Update February 2nd, 2018 The following information from the Medicare Learning Network provides guidance from the Department of Health and Human Services on Cardiovascular Disease Screening Tests:
80061 -
Lipid panel, this panel must include the following:
82465 - Cholesterol, serum, total
83718 - Lipoprotein, direct measurement, high density cholesterol (HDL cholesterol)
84478 - Triglycerides
Z13.6
All Medicare beneficiaries without apparent signs or symptoms ... September 1st, 2017 Preventive Services: Colorectal Cancer ScreeningBy Find-A-Code | Published September 1st, 2017 - Last Review/Update February 2nd, 2018 The following information from the Medicare Learning Network provides guidance on Colorectal Cancer Screening..... September 1st, 2017 Preventive Services: Counseling to Prevent Tobacco UseBy Find-A-Code | Published September 1st, 2017 - Last Review/Update February 2nd, 2018 The following information from the Medicare Learning Network provides guidance on Counseling to Prevent Tobacco Use.... September 1st, 2017 Preventive Services: Diabetes ScreeningBy Find-A-Code | Published September 1st, 2017 - Last Review/Update February 2nd, 2018 The following information from the Medicare Learning Network provides guidance on Diabetes Screening..... September 1st, 2017 Preventive Services: Diabetes Self-Management Training (DSMT)By Find-A-Code | Published September 1st, 2017 - Last Review/Update January 4th, 2018 The following information from the Medicare Learning Network provides guidance on Diabetes Self-Management Training.... September 1st, 2017 Preventive Services: Glaucoma ScreeningBy Find-A-Code | Published September 1st, 2017 - Last Review/Update January 9th, 2018 The following information from the Medicare Learning Network provides guidance on Glaucoma Screening.... September 1st, 2017 Preventive Services: Hepatitis B Virus (HBV) Vaccine and AdministrationBy Find-A-Code | Published September 1st, 2017 - Last Review/Update January 9th, 2018 The following information from the Medicare Learning Network provides guidance on Hepatitis B Virus (HBV) Vaccine and Administration.... September 1st, 2017 Preventive Services: Hepatitis C Virus (HCV) ScreeningBy Find-A-Code | Published September 1st, 2017 - Last Review/Update February 2nd, 2018 The following information from the Medicare Learning Network provides guidance on Hepatitis C Virus (HCV) Screening.... September 1st, 2017 Preventive Services: Human Immunodeficiency Virus (HIV) ScreeningBy Find-A-Code | Published September 1st, 2017 - Last Review/Update January 4th, 2018 The following information from the Medicare Learning Network provides guidance on Human Immunodeficiency Virus (HIV) Screening.... September 1st, 2017 Preventive Services: Influenza Virus Vaccine and AdministrationBy Find-A-Code | Published September 1st, 2017 - Last Review/Update January 4th, 2018 The following information from the Medicare Learning Network provides guidance on Influenza Virus Vaccine and Administration.... September 1st, 2017 Preventive Services: Initial Preventive Physical Examination (IPPE)By Find-A-Code | Published September 1st, 2017 - Last Review/Update February 2nd, 2018 The following information from the Medicare Learning Network provides guidance on Initial Preventive Physical Examination (IPPE)...... September 1st, 2017 Preventive Services: Intensive Behavioral Therapy (IBT) for Cardiovascular Disease (CVD)By Find-A-Code | Published September 1st, 2017 - Last Review/Update January 31st, 2018 The following information from the Medicare Learning Network provides guidance on Intensive Behavioral Therapy (IBT) for Cardiovascular Disease (CVD).... September 1st, 2017 Preventive Services: Intensive Behavioral Therapy (IBT) for ObesityBy Find-A-Code | Published September 1st, 2017 - Last Review/Update January 31st, 2018 The following information from the Medicare Learning Network provides guidance on Intensive Behavioral Therapy (IBT) for Obesity.... September 1st, 2017 Preventive Services: Lung Cancer Counseling and Annual Screening for Lung Cancer With LDCTBy Find-A-Code | Published September 1st, 2017 - Last Review/Update January 31st, 2018 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).... September 1st, 2017 Preventive Services: Medical Nutrition Therapy (MNT)By Find-A-Code | Published September 1st, 2017 - Last Review/Update January 31st, 2018 The following information from the Medicare Learning Network provides guidance on Medical Nutrition Therapy (MNT).... September 1st, 2017 Preventive Services: Pneumococcal Vaccine and AdministrationBy Find-A-Code | Published September 1st, 2017 - Last Review/Update January 31st, 2018 The following information from the Medicare Learning Network provides guidance on Pneumococcal Vaccine and Administration.... September 1st, 2017 Preventive Services: Prostate Cancer ScreeningBy Find-A-Code | Published September 1st, 2017 - Last Review/Update January 31st, 2018 The following information from the Medicare Learning Network provides guidance on Prostate Cancer Screening.... September 1st, 2017 Preventive Services: Screening for Cervical Cancer with Human Papillomavirus (HPV) TestsBy Find-A-Code | Published September 1st, 2017 - Last Review/Update January 31st, 2018 The following information from the Medicare Learning Network provides guidance on Screening for Cervical Cancer with Human Papillomavirus (HPV) Tests.... September 1st, 2017 Preventive Services: Screening for STIs and High Intensity Behavioral Counseling (HIBC) to Prevent STIsBy Find-A-Code | Published September 1st, 2017 - Last Review/Update January 31st, 2018 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..... September 1st, 2017 Preventive Services: Screening MammographyBy Find-A-Code | Published September 1st, 2017 - Last Review/Update January 31st, 2018 The following information from the Medicare Learning Network provides guidance on a Screening Mammography.... September 1st, 2017 Preventive Services: Screening Pap TestsBy Find-A-Code | Published September 1st, 2017 - Last Review/Update January 31st, 2018 The following information from the Medicare Learning Network provides guidance on Screening Pap Tests.... September 1st, 2017 Preventive Services: Screening Pelvic ExaminationsBy Find-A-Code | Published September 1st, 2017 - Last Review/Update January 31st, 2018 The following information from the Medicare Learning Network provides guidance on Screening Pelvic Examinations (includes a clinical breast examination).... November 18th, 2016 Preventive Medical ServicesBy Shannon DeConda | Published November 18th, 2016 - Last Review/Update August 17th, 2017 The guidelines for PMS (Preventive Medicine Services), like those of regular E&M services are gray and leave many puzzling questions to the auditor regarding what is exactly is REQUIRED according to guidelines. In this tip, I will try to address the areas of documentation and provide a relatively concise statement ... July 29th, 2016 Preventive medicine and office visit, same dayBy | Published July 29th, 2016 Can I use modifier 25 on an E/M service on the same day as a preventive medicine exam Let’s review what a preventive medicine service is, in order to answer that question. Preventive medicine services are: • The description given by CPT® for “annual physicals” • Divided into new and... January 6th, 2016 Preventive Medicine Services for Medicare PatientsBy | Published January 6th, 2016 The most widely known fact about Medicare and preventive medicine is that fee-for-service Medicare does not cover an annual physical exam. This is because in its beginning, Medicare was prohibited from paying for routine services. Over the years, Congress has mandated the payment of some screening... July 5th, 2015 Initial Preventive Physical Examination (IPPE) (Rev. 3096, 11-18-14)By | Published July 5th, 2015 (NOTE: For billing and payment requirements for the Annual Wellness Visit, see chapter 18, section 140, of this chapter.)
Background: Sections 1861(s)(2)(w) and 1861(ww) of the Social Security Act (and implementing regulations at 42 CFR 410.16, 411.15(a)(1), and 411.15(k)(11)) authorize coverage under Part B for a one-time initial preventive physical examination ... June 25th, 2015 Medicare Preventive and Screening Services (Rev. 2233, 06-28-11)By | Published June 25th, 2015 The Patient Protection and Affordable Care Act (ACA) amended the definition of “Preventive Services” available in Medicare and included two additional preventive physical examination services: the initial preventive physical examination (IPPE) and the annual wellness visit (AWV).
The definition of preventive services and the corresponding table of services are reflective of ... June 25th, 2015 Definition of Preventive Services (Rev. 2233, 06-28-11)By | Published June 25th, 2015 Section 4104 of the ACA revised section 1861(ddd) of the Social Security Act (the Act) to add subsection (3), which defines the term “preventive services” as follows:
• The specific services currently listed in section 1861(ww)(2) of the Act with the explicit exclusion of electrocardiograms (as specified in section 1861(ww)(2)(M) of ... June 25th, 2015 Table of Preventive and Screening Services (Rev. 3232, 01-05-15)By Jared Staheli | Published June 25th, 2015 Service
CPT/HCPCS Code
Long Descriptor
USPSTF Rating
Coins./ Deductible
Initial Preventive Physical Examination, IPPE
G0402
Initial preventive physical examination; face to face visits, services limited to new beneficiary during the first 12 months of Medicare enrollment
*Not Rated
WAIVED
Initial Preventive Physical Examination, IPPE
G0403
Electrocardiogram, routine ECG with 12 leads; performed as a screening for the initial preventive physical examination with ... June 25th, 2015 Waiver of Cost Sharing Requirements of Coinsurance, Copayment and Deductible for Furnished Preventive Services Available in Medicare (Rev. 2233, 06-28-11)By | Published June 25th, 2015 Section 4104(b)(4) of the ACA, amends section 1833(a)(1) of the Act, by requiring 100 percent payment for the IPPE, AWV and for those preventive services recommended by the United States Preventive Services Task Force (USPSTF) with a grade of A or B for any indication or population and that are ... June 25th, 2015 Carrier - Screening and Preventive Services for Indian Health Services (Rev. 2075, 01-28-11)By | Published June 25th, 2015 Medicare Part B makes payment for the following screening and preventive services:
• Pelvic exam;
• Glaucoma screening;
• Bone mass measurements;
• Prostate cancer screening;
• Colorectal cancer screening;
• Screening pap smear;
• Screening mammography;
• Cardiovascular screening blood tests;
• Diabetes screening tests;
• DSMT;
• Influenza virus vaccine and its administration, pneumococcal vaccine and its administration; hepatitis ... June 25th, 2015 FI - Other Screening and Preventive Services - Payment Policy for Indian Health Services (Rev. 2075, 01-28-11)By | Published June 25th, 2015 Effective January 1, 2005, payment is made by the FI based on the AIR to IHS providers, excluding CAHs, for screening and preventive services covered under §630 of the MMA, indefinitely extended by §2902 of the ACA. Payment is made to CAHs based on cost. Screening and preventive services covered ... June 25th, 2015 FI - Other Screening and Preventive Services - Claims Processing for Indian Health Services (Rev. 1040, 09-11-06)By | Published June 25th, 2015 The screening and preventive services listed in §100.13 of this chapter are reported on TOB 12X, 13X, or 85X with revenue code 0510 (clinic visit).
Services for screening pap smears are only payable by the FI when billed with a pelvic exam. Prostate cancer screening, cardiovascular screening blood tests and screening ... May 11th, 2015 Modifier 33By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | Published May 11th, 2015 - Last Review/Update January 30th, 2017 Modifier 33 for Preventive Care
With the implementation of modifier 33 and its complicated and unique description, many coders have wondered how to properly apply it. Let's review the information we have on the modifier and see if we can better understand how and when to use it.
Modifier 33 was created ... April 15th, 2015 Medicare Updates Preventive Exam and Wellness Visit InformationBy Wyn Staheli, Director of Content | Published April 15th, 2015 - Last Review/Update June 9th, 2016 Medicare has updated their provider educational tools for the Initial Preventive Physical Examination (IPPE) and the Annual Wellness Visit (AWV). These tools were designed to help providers gain a greater understanding of these services. Learn what the required elements for these services as well as important coverage and coding information.
CLICK ... July 16th, 2014 G0402: Medicare Preventive VisitBy | Published July 16th, 2014 - Last Review/Update January 25th, 2017 Medicare covers a one-time Initial Preventive Physical Examination (IPPE), also referred to as the “Welcome to Medicare†visit.  IPPE is a unique benefit available only to patients newly enrolled in the Medicare Program and must be received within the first 12 months of the effective date of their Medicare Part ... There are more articles. View all articles... View articles for the current subject by subtopic:
Select the webinar title to view a summary and link to the webinar video. January 4th, 2018 Proper Coding and Billing for Drugs, Biologicals and InjectionsProper Coding and Billing for Drugs, Biologicals and Injections
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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