Preventive Care Services Health Care Reform The following benefits are effective beginning the first plan year on or after Sept.

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1 Coding Summary for Providers NOTE THE FOLLOWING: The purpose of this document is to provide a quick reference of the applicable codes for UnitedHealthcare plans that cover preventive care services in accordance with the health care reform law. This resource does not replace or supersede the Preventive Care Services Coverage Determination Guideline. If there are any differences between this summary and the Preventive Care Services Coverage Determination Guideline, then the Coverage Determination Guideline takes precedence. Certain UnitedHealthcare plans do NOT use the following codes for preventive care benefits. This document does NOT apply to all UnitedHealthcare members. Please use your existing process for benefit verification such as looking up member benefit information at: UnitedHealthcareOnline.com Codes and (where listed below) are only covered as Preventive when done for a preventive lab procedure that requires a blood draw. See the Preventive Care Services Coverage Determination Guideline for complete coding instructions.. Each member s benefits are defined by his or her benefit plan documents, and any information in the following tables that is inconsistent with the applicable benefit plan documents does not constitute an additional benefit. Benefit adjudication is contingent upon accurate claims submission by the provider, including diagnosis, procedure, age and gender. Preventive Care Services Health Care Reform Abdominal Aortic Aneurysm Anemia, Iron Deficiency Anemia Aspirin for the Prevention of Cardiovascular Disease (Counseling) 76700, 76705, 76770, 76775, G0389 Diagnosis Code(s): V , 85014, 85018, This counseling service is included in a preventive care wellness examination or focused E&M visit. Bacteriuria Behavioral Counseling in Primary Care to Promote a Healthy Diet , , G0270, G0271, G0446, G0447, S Diagnosis Code(s): V77.91, V15.82, V17.3, V17.49, , , V85.41 V85.45, 401.0, 401.1, 401.9, , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , 440.0, 440.1, , , , , , , , , , 440.8, 440.9, , , , , , , , Males. Age p. 1 of 7

2 Behavioral Counseling to Prevent Sexually Transmitted Infections Cervical Cancer, Pap Smear Chemoprevention of Breast Cancer (Counseling) Chlamydia Infection Cholesterol (Lipid Disorders ) Colorectal Cancer , G0445 Code Group 1 (payable regardless of diagnosis code): G0101, G0123, G0124, G0141, G0143 G0145, G0147, G0148, Q0091, P3000, P3001 Code Group 2 (requires a diagnosis code from list below): , 88147, 88148, 88150, , , 88174, Diagnosis Code(s) Code Group 2: V70.0, V72.31, V72.32, V , 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99385, 99386, 99387, 99395, 99396, Diagnosis Code(s): V16.3, V , 86632, 87110, 87270, 87320, 87490, 87491, 87492, 87801, 87810, Diagnosis Code(s): V70.0, V73.88, V73.98, V74.5, V75.9, OR 80061, 82465, 83718, 83719, 83721, 84478, Diagnosis Code(s) (Required for all): V70.0 or V77.91 Additional Diagnosis Codes Required (for Men 20-34, and all Women 20 and up): V15.82, V17.3, V17.49, , , V85.41 V85.45, 401.0, 401.1, 401.9, , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , 440.0, 440.1, , , , , , , , , , 440.8, 440.9, , , , , , , , Fecal Occult Blood Testing, Sigmoidoscopy, or Colonoscopy: Code Group 1 (Preventive regardless of diagnosis code): G0104, G0105, G0106, G0120, G0121, G0122, G0328 Code Group 2 (Preventive if billed in addition to a Code Group 1 code, OR if billed with one of the Diagnosis codes below): 44388, 44389, 44392, 44393, 44394, 45330, 45331, 45333, 45338, 45339, 45378, 45380, 45381, 45383, 45384, 45385, Diagnosis code must be in primary position. All males age 35 and up. Males age if at increased risk for coronary heart disease. Females age 20 and up if at increased risk for coronary heart disease. NOTE: These will only pay as preventive if there is no prior history of a lipid disorder. p. 2 of 7

3 Counseling and Interventions to Prevent Tobacco Use 82270, 82274, 88304, Diagnosis Code(s) (for Code Group 2): V16.0, V18.51, V18.59, V70.0, V76.41, V76.50, V76.51 Computed Tomographic Colonography (Virtual Colonoscopy) (Preventive regardless of diagnosis code): , 99406, 99407, G0436, G0437 Diabetes 82947, 82948, 82950, 82951, 82952, 83036, Diagnosis Code(s): V70.0 or V77.1, PLUS ONE OF THE FOLLOWING HYPERTENSION CODES: 401.0, 401.1, 401.9, , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , Genetic Counseling and Evaluation for BRCA Testing 96040, , , , , S0265 Diagnosis Code(s): V10.3, V10.43, V16.3, V16.41 Gonorrhea 87590, 87591, 87592, 87801, Diagnosis Code(s): V70.0, V74.5, V75.9, OR Hepatitis B Virus Infection HIV Human Immunodeficiency Virus for Adolescents and Adults Immunizations 87340, 87341, 86689, 86701, 86702, 86703, G0432, G0433, G0435, S3645, Diagnosis Code(s): V02.9, V70.0, V73.89, V74.5, V75.9, OR (Underlined codes have coverage limitations listed in right hand column): Administration: 90460, 90461, 90471, 90472, 90473, 90474, G0008, G0009, G0010, G9141; Hepatitis A: 90632, 90633, 90634, 90636; Hemophilus influenza b: 90645, 90646, 90647, 90648; HPV: 90649, ; Influenza virus: 90654, 90655, 90656, 90657, 90658, 90660, 90661, 90662, 90664, 90666, 90667, 90668, Q2035, Q2036, Q2037, Q2038, Q2039; Pneumococcal conjugate: 90669, 90670, S0195; Rotavirus: 90680, 90681; Dtap / Dtpap-IPV, Dtap-Hib-IPV / DTP / DT / Tetanus / Polio / TdaP/ Measles, Mumps, Rubella / MMR: 90696, 90698, 90700, 90701, 90702, 90703, 90704, 90705, 90706, 90707, 90708, 90710, 90713, 90714, 90715, 90718, 90719, 90720, 90721, 90723; Varicella: 90716; Pneumococcal: 90732; NOTE: These will only pay as preventive if there is no prior history of diabetes. Diagnosis code must be in primary position. females is limited to ages is limited to females ages is limited to ages is limited to ages is limited p. 3 of 7

4 Major Depressive Disorder in Children and Adolescents () Metabolic Panel Newborn s Meningococcal: 90733, 90734; Zoster: 90736; Hepatitis B: 90740, 90743, 90744, 90746, 90747, Revenue Code: , G0444 Diagnosis Code(s): V79.0 (Required for only) S3620, 82017, 82136, 82261, 82775, 83020, 83498, 83516, 84030, 84437, 84443, Hearing : V5008, 92551, 92558, Hypothyroidism : 84437, 84443, Phenylketonuria : S3620, 84030, Sickle Cell : S3850, 83020, 83021, 83030, 83033, 83051, Osteoporosis 76977, 77078, 77080, 77081, G0130 Diagnosis Code(s): V17.81, V70.0, V82.81 Prevention of Dental Caries in Preschool Children (Counseling) Primary Care Interventions to Promote Breastfeeding Prostate Cancer RH Incompatibility Rubella By History of Vaccination or by Serology and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse This service is included in the payment for a Preventive Care visit. This service is included in primary care or OB/GYN office visits. Also see Expanded Women s Preventive Care table below. Code Group 1: G0102, G0103, Code Group 2 (requires diagnosis code): 84152, 84153, 84154, Diagnosis Code(s): Code Group 2: V16.42, V70.0, V76.44, V , History of Vaccination: No codes (included in exam) Serology: 86762, Diagnosis Code(s): V70.0 or V , 99409, G0442, G0443 to age 60+. Age 0 90 days. Age 0 90 days. Females, no age Males, age 40 and up. females. p. 4 of 7

5 for Depression in Adults for High Blood Pressure for Obesity in Adults for Obesity in Children and Adolescents for Visual Impairment in Children Mammography 99420, G0444 Diagnosis Code(s): V79.0 (Required for only) This service is included in a preventive care wellness examination or focused E&M visit , 97803, 97804, 99401, 99402, 99403, 99404, G0446, G0447 Diagnosis Code(s) (Required for and ): V85.41 V85.45, , , 97803, 97804, 99401, 99402, 99403, 99404, G0446, G0447 Diagnosis Code(s) (Required for and ): , G0202, 77052, 77057; Revenue code: 0403 Syphilis 86592, 86593, Diagnosis Code(s): V70.0, V74.5, V74.9, V75.9 OR Wellness Examinations (well baby, well child, well adult) Bright Futures: Anemia in Children Developmental/Autism Dyslipidemia Hearing Tests Lead TB Testing G0402, G0438, G0439, G0445, S0610, S0612, S0613, , , , , , 85018, Diagnosis Code(s): V20.2, V20.31, V20.32, V Diagnosis Code(s): V , 82465, 83718, 83719, 83721, 84478, Diagnosis Code(s): V20.2, V , 92552, Diagnosis Code(s): V20.2, V , Diagnosis Code(s): V20.2, V , Diagnosis Code(s): , , V20.2. V74.1 CPT code is only payable as preventive with diagnosis code , or V74.1 * Children less than age 5. Females, no age Ages 24 months to 21 * p. 5 of 7

6 Cancer s: The following is a list of preventive cancer screenings. These are also listed above. Cervical Cancer, Pap Smear Colorectal Cancer Prostate Cancer Mammography Code Group 1 (payable regardless of diagnosis code): G0101, G0123, G0124, G0141, G0143 G0145, G0147, G0148, Q0091, P3000, P3001 Code Group 2 (requires a diagnosis code from list below): , 88147, 88148, 88150, , , 88174, Diagnosis Code(s) Code Group 2: V70.0, V72.31, V72.32, V76.2 Fecal Occult Blood Testing, Sigmoidoscopy, or Colonoscopy: Code Group 1 (Preventive regardless of diagnosis code): G0104, G0105, G0106, G0120, G0121, G0122, G0328 Code Group 2 (Preventive if billed in addition to a Code Group 1 code, OR if billed with one of the Diagnosis codes below): 44388, 44389, 44392, 44393, 44394, 45330, 45331, 45333, 45338, 45339, 45378, 45380, 45381, 45383, 45384, 45385, 82270, 82274, 88304, Diagnosis Code(s) (for Code Group 2): V16.0, V18.51, V18.59, V70.0, V76.41, V76.50, V76.51 Computed Tomographic Colonography (Virtual Colonoscopy) (Preventive regardless of diagnosis code): Code Group 1: G0102, G0103, Code Group 2: (requires diagnosis code): 84152, 84153, 84154, Diagnosis Code(s): Code Group 1: Code Group 2: V16.42, V70.0, V76.44, V84.03 G0202, 77052, 77057; Revenue code: 0403 Males, age 40 and up. Females, no age Pregnancy Diagnosis Code List: The following codes are required only where indicated in the Preventive Care Services table (above), or in the Expanded Women s Preventive Care Services table (below): V22.0 V22.2 V23.0 V23.3, V23.41, V23.42, V23.49, V23.5, V23.7, V23.81 V23.86, V23.87, V23.89, V23.9 V91.00 V91.03, V91.09, V91.10 V91.12, V91.19 V91.22, V91.29, V91.90 V91.92, V91.99 p. 6 of 7

7 Expanded Women s Preventive Care Services Health Care Reform The following benefits are effective beginning the first plan year on or after 8/1/12. Service: Code(s): Limits: Well-Woman Visits Also see Wellness Examinations section in the Preventive Care Services table above. for Gestational Diabetes Human Papillomavirus DNA Testing Counseling for Sexually Transmitted Infections Counseling and for Human Immune-deficiency Virus Contraceptive Methods (Including Sterilizations) NOTE: Certain health plans may qualify for an exemption from covering contraceptive methods and sterilizations. Breastfeeding Support, Supplies, and Counseling and Counseling for Interpersonal and Domestic Violence Annual visits: See the Wellness Examinations section above. Initial Prenatal E&M Visit: ; ; Prenatal Care Visits: 59425, Global Obstetrical Codes*: 59400, 59510, 59610, * The routine, low-risk, prenatal visits portion of the Global Obstetrical code is covered as preventive. Diagnosis Code(s): See Pregnancy Diagnosis Code list above , 82948, 82950, 82951, 82952, 83036, 36415, Diagnosis Code(s): See Pregnancy Diagnosis Code list above Diagnosis Code(s): V70.0, V72.31, V73.81, or V76.2 See the Wellness Examinations section of the Preventive Care Services table above. Counseling: See the Wellness Examinations section of the Preventive Care Services table above. Tests: See the HIV Human Immunodeficiency Virus for Adolescents and Adults section of the Preventive Services table above. Code Group 1: 58565, 58600, 58605, 58611, 58615, 58670, 58671, A4264, 57170, A4261, A4266, J7300 Code Group 2: (requires a diagnosis from list below): 11976, 11981, 11982, 11983, 58300, 58301, J1051, J1055, J1056, J7302, J7306, J7307, S4981, S4989 Code Group 2 Diagnosis Code(s): V25.01, V25.02, V25.03, V25.09, V25.11, V25.12, V25.13, V25.40, V25.41, V25.42, V25.43, V25.49, V25.5, V25.8, V25.9 Code Group 3: (requires diagnosis V25.2): 00940, 00942, 00950, 00952, 01960, 01961, 01965, 01966, 01967, Code Group 3 Diagnosis Code: V25.2 Support and Counseling: S9443, , , (Also see the codes in the Wellness Examinations section of the Preventive Care Services table above.) Diagnosis Code(s): V24.1 (Code V24.1 is required for , , and ) Equipment & Supplies: E0603, E0604, A4281, A4282, A4283, A4284, A4285, A4286 See the Wellness Examinations section of the Preventive Care Services table above. Diagnosis Code(s): See the Wellness Examinations section of the Preventive Care Services table above. females. Females age 30 + N/A p. 7 of 7

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