Procedure: 76700, 76705, 76770, 76775, G0389. Diagnosis: V15.82 Procedure: 80061, 82465, 83718, 83719, 83721, , 36416

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1 Page 1 of Confluence Health & Affiliated Providers Health Plan Preventive Medicine List Service Codes Notes Screening Services Abdominal Aortic Aneurysm Screening One time screening for men ages who have ever smoked. Cholesterol Screening (Lipid Disorders Screening) Men aged if at an increased risk of coronary heart disease. All men 35 and older. Women ages 20 and older if increased risk for coronary heart disease. Colorectal Cancer Screening Fecal occult Blood Testing, Sigmoidoscopy, or Colonoscopy. All adults between the ages of 50 and 75 Computed Tomographic Colonography (Virtual Colonoscopy) 76700, 76705, 76770, 76775, G0389 V , 82465, 83718, 83719, 83721, V70.0 or V77.91 FAMILY or PERSONAL HISTORY: V15.82, V17.3, V OBESITY: , BODY MASS INDEX 40 AND OVER: V85.41-V85.45 ESEENTIAL HYPERTENSION: 401.0, 401.1, SECONDARY HYPERTENSION: , , , , , HYPERTENSION COMPLICATING PREGNANCY, CHILDBIRTH AND THE PUERPERIUM: , , , , , , , , , , , , , , , SECONDARY DIABETES MELLITUS: , , , , , , , , , , , , , , , , , , , DIABETES MELLITUS: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ATHERO-SCLEROSIS: 440.0, 440.1, , , , , , , , , , 440.8, CORONARY ATHERO-SCLEROSIS: , , , , , , , Fecal Occult Blood Testing, Sigmoidoscopy, or Colonoscopy: G0104, G0105, G0106, G0120, G0121, G0122, G0328 Male Ages 65 to 75 Diagnosis code V15.82 Payable for men billed with one procedure code AND with V70.0 or V77.91 Men under the age of 35 with diagnosis V70.0 or V77.91 AND with one of the additional diagnosis codes. Payable for men under the age of 35 billed with ALL the following: -procedure code -V70.0 or V one of the additional codes Women with diagnosis V70.0 or V77.91 and additional Payable for women 20 years and older with ALL the following: -Procedure code V70.0 or V one of the additional codes *Preventive benefit will NOT apply if the following diagnosis codes are present: 272.0, 272.2, or Regardless of age, all codes in the Colorectal Cancer Screening section are reimbursable as preventative. Fecal Occult Blood Testing, Sigmoidoscopy, or Colonoscopy:

2 United Healthcare believes that the use of the Computed Tomographic Colonography as a screening tool is supported by clinical evidence and it is covered as a preventative service. However, it is concluded that the USPSTF decided the evidence is insufficient to assess the benefits and harms of Computed Tomographic Colonography as a screening modality for colorectal cancer. Diabetes Screening Type 2 diabetes screening for asymptomatic adults with sustained blood pressure (treated and untreated) greater than 135/80mm Hg. High Blood Pressure Screening Blood pressure screening is recommended in adults ages 18 and older. HIV- Human Immunodeficiency Virus Screening for Adolescents and Adults As recommended by the Centers for Disease Control and Prevention, all persons, including those not at increased risk, be screened for HIV, including pregnant women. Page 2 of , 44389, 44392, 44393, 44394, 45330, 45331, 45333, 45338, 45339, 45378, 45380, 45381, 45383, 45384, 45385, 82270, 82274, 88304, V16.0, V18.51, V18.59, V70.0, V76.41, V76.50, V76.51 Computed Tomographic Colonography: Procedure Diagnosis , 82948, 82950, 85951, 82952, V70.0 or V77.4, PLUS one of the following: ESSENTAIL HYPERTENSION: 401.0, 401.1, HYPERTENSIVE HEART DISEASE: , , , , , HYPERTENSIVE CHRONIC KIDNEY DISEASE: , , , , , HYPERTENSIVE HEART AND CHRONIC KIDNEY DISEASE: , , , , , , , , , , , SECONDARY HYPERTENSION: , , , , , HYPERTENSION COMPLICATING PREGNANCY, CHILDBIRTH AND THE PUERPERIUM: , , , , , , , , , , , , , , , , 86701, 86702, 86703, G0432, G0433, G0435, S3645 V02.9, V70.0, V73.89, V74.5, V75.9 OR pregnancy Paid as preventative. Paid as preventable IF: Billed with one of the diagnosis codes OR Billed with one of the procedure codes in Group 1. Computed Tomographic Colongraphy: Paid as preventative. Payable when billed with ALL of the following: With one of the Diabetes Screening procedure codes AND With V70.0 or V77.1 AND With one of the hypertension diagnosis codes. Included in prevention care wellness exam Preventative when billed with either one of the diagnosis codes listed or with pregnancy. Payable when billed with BOTH the following- With one of the HIV screening procedure codes AND one of the diagnosis codes or

3 Obesity in Adults Screening Recommended that all adult patients be screened by clinicians for obesity and offered intensive counseling and behavioral interventions to promote and sustain weight loss if needed , 97803, , 99402, 99403, G0446, G0447 Obesity: V85.41-V , pregnancy. E&M service with Modifier 25. preventive care visit. No modifier 25 G0446- limited to one per year. Diagnosis required for , , G0270, G0271 and S9470. NOT for G0446 and G0447 Prostate Cancer Screening Recommended screening for men age 40 and older. Syphilis Screening All persons at risk for syphilis infection and all pregnant women. Aspirin for the Prevention of Cardiovascular Disease (counseling) Aspirin is recommended for men 45 to 79 years of age when the potential benefit due to a reduction in myocardial infarctions outweighs the potential harm due to an increase gastrointestinal hemorrhage. Aspirin is recommended for women 55 to 79 years of age when the potential benefit of a reduction in ischemic strokes outweighs the potential harm of an increase in gastrointestinal hemorrhage G0102, G0103 (requires diagnosis code) 84152, 84153, V16.42, V70.0, V76.44, V , V70.0, V74.5, V74.9, V75.9 OR Behavioral Health Screening / Counseling All men 40 and over regardless of diagnosis. Payable when billed with G0103 All men 40 and over when billed with Payable when billed with: 84152, or AND with a Payable with pregnancy diagnosis or one of the diagnosis codes listed. Payable when billed with BOTH the following: Listed procedure code AND a diagnosis code or pregnancy diagnosis. Service included in prevention care wellness exam or focused E&M visit. Page 3 of 12

4 Alcohol Misuse- Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse Recommended screening and behavioral counseling interventions to reduce alcohol misuse by adults, including pregnant women, in primary care settings. Depression in Adults- Screening The screening of adults for depression when staff-assisted depression care supports are in place to assure accurate diagnosis, effective treatment, and follow-up is recommended. Diet- Behavioral Counseling in Primary Care to Promote a Healthy Diet. Behavioral dietary counseling for adults with hyperlipidemia and other known risk factors for cardiovascular and dietrelated chronic disease is recommended. Primary care clinicians, or a specialist (nutritionist or dietitian) by referral, can deliver intensive counseling. Page 4 of , 99409, G0442, G , G0444 V79.0 (required for 99720) , , G0270, G0271, G0446, G0447, S9470 Screening: V77.91 History: V15.82, V17.3, V17.49 Obesity: , V85.41-V85.45 Essential Hypertension: 401.0, 401.1, Secondary Hypertension: , , , , , Hypertension Complicating, Childbirth, and the Puerperium: , , , , , , , , , , , , , , , Secondary Diabetes Mellitus: , , , , , , , , , , , , , , , , , , , Diabetes Mellitus: , , , , , , , , , , , , , , , , , , , , , , , , , , , , E&M service appended with Modifier 25. preventative care visit. No modifier 25 V79.0 is NOT required for G0444 E&M service with Modifier 25. preventive care visit. No modifier 25 G0446- limited to one per year. Diagnosis required for , , G0270, G0271 and S9470. NOT for G0446 and G0447

5 STI- Behavioral Counseling to Prevent Sexually Transmitted Infections High-intensity behavioral counseling is recommended to prevent sexually transmitted infections (STIs) for all sexually active adolescents and for adults at increased risk for STIs. Tobacco- Counseling and Interventions to Prevent Tobacco Use and Tobacco-caused Disease in Adults and Pregnant Women Counseling and Interventions It is recommended to ask all adults about tobacco use, by clinicians, and provide tobacco cessation interventions for those who use tobacco products. It is recommended to ask all pregnant women about tobacco use, by clinicians, and provide augmented, pregnancytailored counseling for those who smoke. Wellness Examinations Well baby, well child, well adult: HHS Requirements: The codes include the following for women: -Breastfeeding support and counseling -Contraceptive methods counseling -Domestic violence screening -Annual HIV counseling -Sexually Transmitted Infections counseling -Well-woman visits Immunizations Page 5 of , , , , , , , , , , , Athero-Sclerosis: 440.0, 440.1, , , , , , , , , , 440.8, Coronary Athero-Sclerosis: , , , , , , , G , G0436, G Exams and Immunizations G0402, G0438, G0439 G0445, S0610, S0612, S E&M service with Modifier 25. preventive care visit. No modifier 25 G0445- limited to twice per year. E&M service with Modifier 25. preventive care visit. No modifier 25 Payable as preventative regardless of diagnosis. G0445 is limited to twice a year. G0445, S0610, S0611, S0612, 99411, 99412: E&M service appended with Modifier 25. preventative care visit. No modifier 25 Always preventative regardless of

6 An immunization that does not fall under one of the exclusions in the Certificate of Coverage is considered covered after the following conditions are satisfied: FDA approval, Explicit ACIP recommendation published in the MMWR (Morbidity & Mortality Weekly Report) or the CDC (Centers for Disease Control and Prevention). Implementation will typically occur within 60 days after publication in the MMWR. Anemia- Iron Deficiency Anemia Screening Asymptomatic pregnant women Bacteriuria Screening Pregnant women at weeks gestation or at first prenatal visit. (if later than 16 weeks) Breastfeeding Support, Supplies, and Counseling Comprehensive lactation support and counseling, from a trained provider, during pregnancy and/or in the postpartum period, and costs for renting breastfeeding equipment, in conjunction with each birth. Page 6 of 12 Immunization Administration: 90460, 90461, 90471, 90472, 90473, 90474, G0008, G0009, G0010, G9141 Hepatitis A; 90632, 90633, 90634, Hemophilus influenza b: 90645, 90646, 90647, HPV: 90649, Influenza virus: 90654, 90655, 90656, 90657, 90658, 90660, 90661, 90662, 90664, 90666, 90667, 90668, Q2034, Q2035, Q2036, Q2037, Q2038, Q2039 Pneumococcal conjugate: 90669, 90670, S0195 Rotavirus: 90680, Dtap/ Dtpap-IPV, Dtap-Hib- IPV/DTP/DT/Tetanus/ Polio/ TdaP/ Measles, Mumps, Rubella/ MMR: 90696, 90698, , 90710, 90713, 90714, 90715, 90718, 90719, 90720, 90721, Varicella: Pneumococcal: Meningococcal: 90733, Zoster: Hepatitis B: 90740, 90743, 90744, 90746, 90747, Revenue Code: 0771 Women s Preventive Health 85013, 85014, Support and Counseling: S9443, , , Also see Wellness Examinations V24.1 diagnosis. Payable with diagnosis. Payable when billed with one of the Anemia procedure codes AND a pregnancy diagnosis. Payable with pregnancy diagnosis. Support and Counseling: Code V24.1 is required for , , Code V24.1 is NOT required for A9443

7 Cervical Cancer Screening, Pap Smear Women who have been sexually active and have a cervix Chemoprevention of Breast Cancer (counseling) It is recommended that clinicians discuss chemoprevention with women at high risk for breast cancer and that low risk for adverse effects of chemoprevention. Potential benefits and harms of chemoprevention should also be discussed. Chlamydia Infection Screening All sexually active, non-pregnant women aged 24 and younger. And for older pregnant women who are at increased risk. Contraceptive Methods Including Sterilization All Food and Drug Administrationapproved contraceptive methods, sterilization procedures, and patient education and counseling for women. See Wellness Examinations for patient education and counseling. *Certain health plans sponsored by religious employers may qualify for an exemption from covering contraceptive methods and sterilization. Page 7 of 12 Equipment and Supplies: E0603, E0604, A4281, A4282, A4283, A4284, A4285, A4286 G0101, G0123, G0124, G0141, G0143, G0144, G0145, G0147, G0148, Q0091, P3000, P , 88142, 88143, 88147, 88148, 88150, 88152, 88153, 88154, 88155, 88164, 88165, 88166, 88167, 88174, V70.0, V72.31, V72.32, V , 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99385, 99386, 99387, 99395, 99396, V16.3, V , 86632, 87110, 87270, 87320, 87490, 97491, 87492, 87801, V70.0, V73.88, V73.98, V74.5, V75.9 OR pregnancy Sterilizations: 55250, 58565, 58600, 58605, 58611, 58615, 58670, 58671, A4264 Contraceptive Methods: 57170, A4261, A4266, J7300 Contraceptive Methods: 11976, 11981, 11982, 11983, 58300, 58301, J1051, J1055, J1056, J7302, J7306, J7307, S4981, S4989 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 Equipment and Supplies: Code E0604 is allowed when rental modifier RR is attached. Payable for all women, regardless of Payable for all women with at least one the diagnosis codes. Payable as preventive when billed with one of the diagnosis codes in the primary position. -All Women -Payable with pregnancy diagnosis. -With one of the diagnosis codes. With 86631, AND one of the diagnosis codes OR pregnancy diagnosis. Always preventative, regardless of Preventive when billed with Group 2

8 Genetic Counseling and Evaluation for BRCA Testing Woman whose family history is associated with an increased risk for deleterious mutations in BRCA1 or BRCA2 genes. Gestational Diabetes Screening At first prenatal visit for those who are at high risk of developing gestational diabetes, or woman who are 24 to 28 weeks pregnant. Gonorrhea Screening All sexually active women, pregnant or non-pregnant, with an increased risk of infection. Hepatitis B Virus Infection Screening Pregnant women at first prenatal visit. Human Immune-deficienty Virus Screening and Counseling Screening and counseling for human immune-deficiency virus infection for all sexually active women is required. Human Papillomavirus DNA Testing Every 3 years for woman who are 30 or older who have normal pap smear results is required. Interpersonal and Domestic Page 8 of 12 Group 3: Anesthesia for Sterilization: 00940, 00942, 00950, 00952, 01960, 01961, 01965, 01966, 01967, V , 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99385, 99386, 99387, 99395, 99396, 99397, S0265 V10.3, V10.43, V16.3, V , 82948, 82950, 82951, 82952, , 87591, 87592, 87801, V70.0, V74.5, V75.9 OR pregnancy 87340, Screening Tests: Use the codes for HIV- Human Immunodificiency Virus screening codes. Counseling: Use the Wellness Examinations codes , 87621, V70.0, V72.31, V73.81, or V76.2 See Wellness Examinations Group 3: Preventive when billed with diagnosis code V25.2 Payable as preventative with diagnosis codes in primary position. Payable with diagnosis Payable when billed with ALL the following, With one of the Diabetes screening procedure codes AND a pregnancy diagnosis. DO NOT PAY as preventive: If or through diagnosis is present in ANY position. Female Payable with pregnancy or other diagnosis code listed. Payable with pregnancy diagnosis. Payable with Hep B screening procedure code AND a pregnancy diagnosis. Screening Tests: See HIV- Human Immunodificiency Virus screening. Counseling: See Wellness Examinations. Women 30 years and older. Payable as preventive screening with

9 Violence Screening and Counseling Screening and counseling for interpersonal and domestic violence. Osteoporosis Screening Recommended screening for women age 65 and older, and in younger women whose fracture risk is equal to or greater than that of a 65 year old white woman who has no additional risk factors. Primary Care Interventions to Promote Breastfeeding An intervention during pregnancy and after birth to promote and support breastfeeding is recommended. See Wellness Examinations 76977, 77078, 77080, 77081, G0130 V17.81, V70.0, V82.81 All women, using one of the diagnosis codes. Included in primary care or OB/GYN office visits. RH Incompatibility Screening All pregnant women during their first prenatal visit. All unsensitized Rh-negative women at weeks gestation, unless the biological father is Rh-negative. Rubella Screening By History of Vaccination or by Serology All women of child bearing age at their first clinical appointment. STI- Counseling for Sexually Transmitted Infections Counseling on sexually transmitted infections for all sexually active women is required. Mammography Screening Mammogram screening is recommended every 1-2 years, with or without clinical breast examination (CBE) for women aged 40 and over. Well-Woman Visits Well-woman preventive care visit annually for adult women to obtain the recommended services that are age and Page 9 of History of Vaccination- No codes Serology: V70.0 or V73.3 Use codes from Wellness Examinations G0202, 77052, Revenue code: 0403 Well woman visits: (see Wellness Examinations) Prenatal E&M: , , Payable with pregnancy diagnosis Payable when billed with and pregnancy diagnosis. Female Payable with diagnosis V70.0 or V73.3. Payable for females when billed with AND either See Wellness Examinations. Payable with all adult women regardless of age or diagnosis. Well-woman: Payable as preventative regardless of diagnosis. Prenatal E&M:

10 developmentally appropriate, this includes preconception and prenatal care. Prenatal care: 59425, Global Obstetrical Codes: 59400, 59510, 59610, Payable as preventative when billed with diagnosis. Prenatal Care: Payable as preventative regardless of diagnosis. Diagnosis Codes: Anemia Screening in Children Dental- Prevention of Dental Caries in Preschool Children (Counseling) V22.0-V22.2, V23.0-V23.3, V23.42, V23.5, V23.81-V23.83, V23.87, V23.89, V23.9, V V91.03, V94.10-V91.12, V91.99, V91.90-V91.92 Children s Screening/Counseling 85014, V20.2, V20.31, V20.32, V78.0 Global Obstetrical Codes: Routine, low risk, prenatal visits portion of the code is covered as preventive. diagnosis is not required. Prenatal to age 21 No frequency limit. Payable as preventive with codes 85014, and diagnosis. Prenatal to age 21, payable when bill with or AND Included in preventive care visit. It is recommended that primary care clinicians prescribe oral fluoride supplementation at recommended doses to preschool children older than 6 months whose primary water source is deficient in fluoride. Developmental/Autism Screening Dyslipidemia Screening Hearing Tests Lead Screening Page 10 of V , 82465, 83718, 83719, 83721, V20.2, V , 92552, V20.2, V Prenatal to age 21 No frequency limit. Payable as preventive with at least one Ages 24 months to 21 years of age Payable as preventive with at least one diagnosis codes. 24 months to age 21, payable when bill with procedure code AND Prenatal to age 21 One time per year Payable as preventive with at least one Prenatal to age 21 No frequency limit. Payable as preventive with at least one

11 Major Depressive Disorder in Children and Adolescents (Screening) The recommended screening of adolescents ages 12 to 18, for major depression disorder (MDD) when systems are in place to ensure accurate diagnosis, psychotherapy (interpersonal or cognitive-behavioral), and follow up. Metabolic Screening Panel Newborn Screenings All newborns Obesity in Children and Adolescents Screening Recommended that children age 6 and older be screened by clinicians for obesity and offer them or refer them to comprehensive, intensive behavioral interventions to promote improvement in weight status. Skin Cancer- Behavioral Counseling to Prevent Skin Cancer Counseling children, adolescents, and young adults (10-24 years of age) who Page 11 of 12 C20.2, V , G0444 V79.0 (required for 99420) S3620, 82017, 82136, 82261, 82775, 83020, 83498, 83516, 84030, 84437, , Hearing Screening: V5008, 92551, 92558, 92585, 92586, 92587, Hypothyroidism Screening: 84437, 84443, Phenylketonuria Screening: S3620, 84030, Sickle Cell Screening: S3850, 83020, 83021, 83030, 83033, 83051, 97802, 97803, 97804, 99402, 99402, 99406, G0446, G0447 Obesity: , Prenatal to age 21, payable when bill with AND V79.0 is NOT required for G0444 Age 0 90 days, regardless of diagnosis. Payable when billed with one of the procedure codes. Age 0-90 days, regardless of diagnosis. Payable when billed with one of the listed Hypothyroidism, Phenylketonuria, or Sickle Cell Screening procedure codes. E&M service with Modifier 25. preventive care visit. No modifier 25 G0446- limited to one per year. Diagnosis required for , , G0270, G0271 and S9470. NOT for G0446 and G0447 Included in preventive care wellness exam or focused E&M visit.

12 have fair skin, about minimizing their exposure to ultraviolet radiation to reduce the risk of skin cancer is recommended. TB Testing Visual Impairment in Children Screening Vision screening for all children between the ages of 3 and 5 years, at least once to detect the presence of amblyopia or its risk factors is recommended , , , V20.2, V Prenatal to age 21 No frequency limit. Payable as preventive with at least one is payable as preventive with at least one is only payable as preventive with diagnosis , or V74.1 Under 5 years of age. Included in preventive care visit payment. Payable if billed separate. Non-payable if billed with preventive care visit. Page 12 of 12

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