PREVENTIVE CARE SERVICES GUIDELINES

Size: px
Start display at page:

Download "PREVENTIVE CARE SERVICES GUIDELINES"

Transcription

1 PREVENTIVE CARE SERVICES GUIDELINES SHPO reimburses providers for s rendered below as preventive benefits with a $0.00 cost share to the member. If coded as indicated in the model, members pay $0.00 for the. Providers may also append Modifier 33 to indicate a preventive as appropriate in accordance with billing standards. Annual Wellness/Physical Exam: Service includes either an Initial Preventive Physical Examination or an Annual Wellness Visit or a Comprehensive Preventive Exam, and any Laboratory Services performed. Abdominal Aortic Aneurysm Screening: Men N/A The USPSTF recommends one-time screening for abdominal aortic aneurysm by ultrasonography in men aged 65 to 75 who have ever smoked , or G0402, G0438, G0439, G0468, S S0613 provided and lab tests ordered or conducted during the visit , 76705, 76770, 76775, G0389 ICD-9: V70.0, V72.62, V20.2, V72.31, V76.2, V76.47 ICD-10: Z00.00, Z00.01, Z00.121, Z00.129, Z01.411, Z01.419, Z12.4, Z12.72 ICD-9: V15.82 ICD-10: Z All members. Frequency per benefit is covered in compliance with the USPSTF, Bright Futures and SACHDNC recommendations Males age who have ever smoked. year Alcohol Misuse Counseling The USPSTF recommends that clinicians screen adults aged 18 years or older for alcohol misuse and provide persons engaged in risky or hazardous drinking with brief behavioral counseling interventions to reduce alcohol misuse. G0442-G0443 or G0396 G0397 is included in a preventive care visit. Codes: Men and Women age 18+. year Page 1

2 Anemia Screening: Pregnant Women Aspirin To Prevent CVD: Men and Women Aspirin to Prevent Preeclampsia in Pregnant Women Bacteriuria Screening: Pregnant Women Behavioral/Psychosocial Assessments The USPSTF recommends routine screening for iron deficiency anemia in asymptomatic pregnant women. The USPSTF recommends the use of aspirin for men age 45 to 79 years and women age 55 to 79 years when the potential benefit due to a reduction in myocardial infarctions outweighs the potential harm due to an increase in gastrointestinal hemorrhage. The USPSTF recommends the use of low-dose aspirin (81 mg/d) as preventive medication after 12 weeks of gestation in women who are at high risk for preeclampsia. The USPSTF recommends screening for asymptomatic bacteriuria with urine culture for pregnant women at 12 to 16 weeks' gestation or at the first prenatal visit, if later. Bright Futures recommends conducting Psychosocial/Behavioral assessments and alcohol and drug assessments Payable with diagnosis of pregnancy Codes: , G0446 appropriate to the Codes Payable with diagnosis of pregnancy Payable with diagnosis of pregnancy or Codes: 96127, , G0444 Pregnant Women. year Men, Ages and Women, Ages year After 12 weeks of gestation. Pregnant Women at 12 to 16 weeks gestation or at the first prenatal visit, if later. Children and Adolescents 0 21 years. Frequency per benefit is covered in compliance with the Page 2

3 Bright Futures recommendations Blood Pressure Screening Breast Cancer Genetic Risk Assessment and BRCA Mutation Testing (Counseling) Breast Cancer Genetic Risk Assessment and BRCA Mutation Testing (Testing) Breast Cancer Preventive Medication The USPSTF and HRSA recommend screening for high blood pressure in children ages 0-11 months, 1-11 years, adolescents 12-17, adults 18+ and older. The USPSTF recommends that women whose family history is associated with an increased risk for deleterious mutations in BRCA1 or BRCA2 genes be referred for genetic counseling. The USPSTF recommends that women whose family history is associated with an increased risk for deleterious mutations in BRCA1 or BRCA2 genes be referred for evaluation for BRCA testing. The USPSTF recommends that clinicians engage in shared, informed decision making with women who are at increased risk for breast cancer about medications to reduce their risk. For women who are at increased risk for preventive care and/or well-child visit. Codes: Codes: or and S , , Codes: ICD-9: V16.3 or V16.41 ICD-10: Z80.3 or Z80.41 ICD-9: V16.3 or V16.41 ICD-10: Z80.3 or Z80.41 Children 0-11 months, 1-11 years, Adolescents 12-17, Men and Women age 18+. or during wellchild visits. Women with a family history of ovarian cancer or breast cancer. Women with a family history of ovarian cancer or breast cancer. Women at high risk for breast cancer and at low risk for adverse effects of chemoprevention. Page 3

4 Breast Cancer Screening Breastfeeding Counseling Breastfeeding Supplies and Support Cervical Cancer Screening breast cancer and at low risk for adverse medication effects, clinicians should offer to prescribe risk-reducing medications, such as tamoxifen or raloxifene. The USPSTF recommends screening mammography for women, with or without clinical breast examination, every 1-2 years for women aged 40 and older. The USPSTF recommends interventions during pregnancy and after birth to promote and support breastfeeding. The HRSA recommends comprehensive lactation support and counseling, by a trained provider during pregnancy and/or in the postpartum, and costs for renting breastfeeding equipment. The USPSTF recommends screening for cervical cancer in women ages 21 to 65 years with cytology (Pap smear) every 3 years or, for women ages 30 to 65 years who want to lengthen the screening interval, screening with a combination of cytology and human papillomavirus (HPV) testing every 5 years , 77056, 77057, 77051, 77052, G0202, G0204, G0206 Codes: A4281-A4286, E0602-E0604 (with modifier RR), S9443 G0101, G G0124, G0141- G0148, P P3001, Q0091, , , , , Women age 40+. Pregnant Women or Postpartum Women. 3 times per benefit Pregnant and nursing women. In conjunction with each birth Females. Page 4

5 Chlamydial Infection Screening: Women Cholesterol Abnormalities Screening: Men and Women Colorectal Cancer Screening Congenital Heart Disease Screening for Newborns The USPSTF recommends screening for chlamydial infection for all sexually active pregnant and non-pregnant young women aged 24 and younger and for older pregnant and non-pregnant women who are at increased risk. The USPSTF recommends screening men aged 20 to 35 and 35 and older for lipid disorders if they are at increased risk for coronary heart disease. The USPSTF also recommends screening women aged 20 to 45 and 45 and older for lipid disorders if they are at increased risk for coronary heart disease. The USPSTF recommends screening for colorectal cancer using fecal occult blood testing, sigmoidoscopy, or colonoscopy, in adults, beginning at age 50 years and continuing until age 75 years. The risks and benefits of these screening methods vary. Bright Futures recommends screening newborns for congenital heart disease using pulse oximetry after 24 hours of age, before discharge from the hospital , 87110, 87270, 87320, , 87810, and , 82465, , G G0106, G0120-G0122, G0328, G0464, G6019, G6021- G6022, G6024-G6025, 00810, , , , , , 45399, , Women age 18+. ICD-9: V17.3, V17.49, V77.91, V81.0, V81.1, V81.2 ICD-10: Z82.49, Z13.220, Z13.6 ICD-9: V76.41 or V76.51 ICD-10: Z12.11-Z12.12 Men, Ages 20 + and Women, Ages Men and Women ages years. as clinically appropriate based on clinical care guidelines 94760, 94761, Newborns after 24 hours of age, but before discharged. Page 5

6 Contraceptive Methods and Counseling The HRSA recommends all Food and Drug Administration (FDA) approved contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive capacity , 11983, 57170, 58565, , , , 96372, A4261, A4264, A4266- A4269, J1050, J7300-J7307, S4981-S4989 Counseling: or ICD-9: V V25.03, V25.11, V25.13 or V25.40-V25.5. ICD-10: Z Z30.019, Z30.40-Z30.49, Frequency per benefit is covered in compliance with the Bright Futures recommendations All women with reproductive capacity. As prescribed Providers should bill appropriately for s rendered, including appending appropriate modifiers. Dental Caries Chemoprevention: Preschool Children The USPSTF recommends that primary care clinicians prescribe oral fluoride supplementation at currently recommended doses to preschool children older than 6 months of age whose primary water source is deficient in fluoride. The USPSTF also recommends that primary care clinicians apply fluoride varnish to the primary teeth of all infants and children starting at the age of primary tooth eruption. Codes: 99188, , appropriate to the Children ages 6 months to 5 years. Page 6

7 Depression Screening: Adolescents and Adults Developmental Assessments The USPSTF recommends screening of adolescents (12-18 years of age) for major depressive disorder when systems are in place to ensure accurate diagnosis, psychotherapy (cognitivebehavioral or interpersonal), and followup. The USPSTF also recommends screening adults for depression when staff-assisted depression care supports are in place to assure accurate diagnosis, effective treatment, and follow-up. Bright Futures recommends performing developmental screening, autism screening and developmental surveillance. Codes: , 96127, appropriate to the or ICD-9: V79.0 ICD-10: Z13.89 Adolescents and Adults, ages and 18+. Children ages 0-3 years. Frequency per benefit is covered in compliance with the Bright Futures recommendations Diabetes Screening Dyslipidemia Screening The USPSTF recommends screening for type 2 diabetes in asymptomatic adults with sustained blood pressure (either treated or untreated) greater than 135/80 mm Hg. The HRSA recommends screening for children and adolescents that are at a higher risk of lipid disorders. Screening , ICD-9: V77.1 ICD-10: Z13.1 and/or payable with a diagnosis of high blood pressure ICD-9: V77.91, V81.2 ICD-10: Men and Women ages 18+. Children and Adolescents ages 1-17 years. Page 7

8 should be performed during a well-child visit. Bright Futures recommends an additional Dyslipidemia screening between 9 and 11 years of age. Z13.220, Z13.6 Frequency per benefit is covered in compliance with the Bright Futures recommendations Folic Acid Supplementation Gestational Diabetes Screening Gonorrhea Prophylactic Medications: Newborn The USPSTF recommends that all women planning or capable of pregnancy take a daily supplement containing 0.4 to 0.8 mg (400 to 800 µg) of folic acid. The HRSA recommends gestational diabetes screening in pregnant women between of gestation and at the first prenatal visit for pregnant women identified to be at high risk for diabetes. The USPSTF strongly recommends prophylactic ocular topical medication for all newborns against gonococcal ophthalmia neonatorum. Codes: ICD-9: , V22.0-V23.9, or V12.21 ICD-10: O0900- O0993, Z13.1, Z33.1, Z34- Z34.93, Z39.0- Z39.2, Z86.32 Codes: Women ages 18+. Pregnant women. Pregnant women between weeks gestation and/or the first prenatal visit for pregnant women identified as high risk for diabetes Newborns age 0-3 months. Page 8

9 Gonorrhea Screening: Women Healthy Diet Counseling The USPSTF recommends that clinicians screen all sexually active women, including those who are pregnant, for gonorrhea infection if they are at increased risk for infection (that is, if they are young or have other individual or population risk factors). The USPSTF recommends intensive behavioral dietary counseling for adult patients with hyperlipidemia and other known risk factors for cardiovascular and diet-related chronic disease. Intensive counseling can be delivered by primary care clinicians or by referral to other specialists, such as nutritionists or dietitians , 87850, 87800, 87081, 87210, 87070, 87077, G , S9470, G G0271, G0446 G0447, G0473, or may be included in a Codes: Payable with diagnosis of pregnancy or ICD-9: V69.2, V74.5, V76.2, or V01.6 ICD-10: O09.00-O09.93, Z00.0, Z01.411, Z01.419, Z33.1, Z34-Z34.93, Z39.0-Z39.2 Payable with a diagnosis of hyperlipidemia, and/or with a diagnosis related to cardiovascular disease, and/or a diet-related chronic disease Women ages 18+ who have been sexually active, and/or are pregnant. Men and Women age 18+ who have hyperlipidemia or other known risk factors for cardiovascular disease or diet-related chronic disease. 6 hours per benefit Page 9

10 Hearing Loss Screening: Newborns The USPSTF recommends screening for hearing loss in all newborn infants , 92558, , V5008 Children ages 0-10 years. Frequency per benefit is covered in compliance with the Bright Futures recommendations Hemoglobinopathies Screening: Newborns Hepatitis B Screening: Pregnant Women and All Persons at high risk of infection Hepatitis C Virus Infection Screening: Adults Hematocrit or Hemoglobin Risk Assessment Recommends screening for sickle cell disease in newborns. The USPSTF strongly recommends screening for hepatitis B virus infection in pregnant women at their first prenatal visit and screening in all persons at high risk for infection. The USPSTF recommends screening for hepatitis C virus (HCV) infection in persons at high risk for infection. The USPSTF also recommends offering onetime screening for HCV infection to adults born between 1945 and Bright Futures recommends a hematocrit or hemoglobin risk assessment between the ages of months , S3620 Newborns age 0-3 months , Men and Women with an increased risk and/or are pregnant. year , G0472 Men and Women born between 1945 and 1965 and who are at high risk Children ages months Page 10

11 HIV Screening Human Papillomavirus (HPV) Screening: Women Hypothyroidism Screening: Newborns Intimate Partner Violence Screening for Women of Childbearing age Iron Supplementation in Children The USPSTF strongly recommends that clinicians screen for human immunodeficiency virus (HIV) all adolescents and adults at increased risk for HIV infection. Bright Futures recommends that those between the ages of be screened at least once. The HRSA recommends high-risk human papillomavirus DNA testing in women with normal cytology results. The USPSTF recommends screening for congenital hypothyroidism in newborns. The USPSTF recommends that clinicians screen women of childbearing age for intimate partner violence, such as domestic violence, and provide or refer women who screen positive to intervention s. This recommendation applies to women who do not have signs or symptoms of abuse. The USPSTF recommends routine iron supplementation for asymptomatic , , 86689, , 87806, G0432, G0433. G0435, S3645 Men and Women age 13 + with an increased risk and/or are pregnant. Frequency per benefit is covered in compliance with the Bright Futures recommendations Women age 30+ who are high-risk , 84443, S3620 Frequency is no more than every 3 years Newborns age 0-3 months All women. Children age 6 12 months old. Page 11

12 Lung Cancer Screening Lead Screening children aged 6 to 12 months who are at increased risk for iron deficiency anemia. The USPSTF recommends annual screening for lung cancer with low-dose computed tomography (LDCT) in adults aged 55 to 80 years who have a 30 packyear smoking history and currently smoke or have quit within the past 15 years. Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery. The HRSA recommends lead screening for children who at risk of exposure. Codes: S8032 ICD-9: 305.1, V15.82, or V76.0 ICD-10: F F17.219, Z87.891, Z12.2 Men and Women ages years old year Children age 6 and younger. Obesity Screening and Counseling: Adults The USPSTF recommends that clinicians screen all adult patients for obesity and offer intensive counseling and behavioral interventions to promote sustained weight loss for obese adults , S9470, G G0271, G0446 G0447, G0473, or may be included in a Codes: for the screening. The counseling is payable with an Obesity diagnosis Men and Women age hours per benefit Page 12

13 Obesity Screening and Counseling: Children Osteoporosis Screening: Women PKU Screening: Newborns The USPSTF recommends that clinicians screen children aged 6 years and older for obesity and offer them or refer them to comprehensive, intensive behavioral interventions to promote improvement in weight status. The USPSTF recommends that women aged 65 and older be screened routinely for osteoporosis. The USPSTF recommends that routine screening begin at age 60 for women at increased risk for osteoporotic fractures. The USPSTF recommends screening for phenylketonuria (PKU) in newborns , S9470, G G0271, G0446 G0447, G0473, or may be included in a Codes: , , , and G0130 for the screening. The counseling is payable with an Obesity diagnosis ICD-9: V17.81, V82.81 ICD-10: Z82.62, Z or payable with diagnosis related to bone disease Children age hours per benefit Women age , S3620 Newborns age 0-3 months. Rh Incompatibility Screening: First Pregnancy Visit and Weeks Gestation The USPSTF strongly recommends Rh (D) blood typing and antibody testing for all pregnant women during their first visit for pregnancy-related care, and repeating Rh (D) antibody testing for all unsensitized Rh (D)-negative women at weeks' gestation, unless the biological father is known to be Rh (D)- negative , 86850, Payable with diagnosis of pregnancy Pregnant Women week s gestation and first prenatal visit. 2 per benefit Page 13

14 STIs Counseling Tobacco Use Counseling: Pregnant Women and Non- Pregnant Adults Syphilis Screening: Non- Pregnant Persons and Pregnant Women The USPSTF recommends intensive behavioral counseling for all sexually active adolescents and for adults who are at increased risk for sexually transmitted infections (STIs). The USPSTF recommends that clinicians ask all adults about tobacco use and provide tobacco cessation interventions for those who use tobacco products. Clinicians should also ask all pregnant women about tobacco use and provide augmented, pregnancy-tailored counseling to those who smoke. The USPSTF also recommends that clinicians provide interventions, including education or brief counseling, to prevent initiation of tobacco use in school-aged children and adolescents. The USPSTF strongly recommends that clinicians screen persons at increased risk for syphilis infection including pregnant women. G0445 or with preventive care visit codes: G G0437, G9016, S9453, or with preventative care visit codes: , 86780, ICD-9: V V65.45, V69.2 or V01.6 ICD-10: Z71.7, Z71.89, Z Z72.53, Z20.2 Payable with diagnosis of ICD-9: or V15.82 ICD-10: F17.2, Z Payable with diagnosis of pregnancy or with ICD-9: V V23.9 or , or V65.45, V69.2, V01.6 or V74.5 ICD-10: O09.00-O09.93, Men and Women age hours per benefit Men and Women ages 18 + and/or are pregnant. Men and Women ages 18+ and/or are pregnant. Page 14

15 TB Testing Visual Acuity Screening in Children USPSTF recognizes the importance of targeted screening for tuberculosis. Per the Centers for Disease Control and Prevention (CDC). The USPSTF recommends screening to detect amblyopia, strabismus, and defects in visual acuity in children in accordance with Bright Futures. Z11.3, Z33.1, Z34-Z34.493, Z , Men and Women ages , or S S0621 ICD-9: V72.0 ICD-10: Z01.00-Z01.01 Children ages 0-21 years. Frequency per benefit is covered in compliance with the Bright Futures recommendations Page 15

16 Well-Women Visits The HRSA recommends a preventive annual visit for adult women to obtain the recommended preventive s that are age and developmentally appropriate, including preconception and prenatal care , or as are payable when billed with a diagnosis of ICD-9: or V22.0-V23.9 ICD-10: Z34- Z34.493, Z33.1, O09.00-O09.93 Women and Pregnant Women. Annual. SHPO recognizes that several visits may be necessary to obtain all necessary recommended preventive s, depending on a woman s health status, needs, and other risk factors These guidelines represent a compilation of recommendations from the United States Preventive Services Task Force (USPSTF), recommendations for Preventive Pediatric Health Care Bright Futures/American Academy of Pediatrics, the Secretary s Advisory Committee on Heritable Disorders in Newborns and Children, and US Department of Health and Human Services Health Resources and Services Administration (HRSA). SHPO will make any additions or revisions in accordance with changes in the recommendations for preventive s issued by the Departments of Health and Human Services (HHS), Labor, and Treasury. SHPO reserves the right to amend and ICD-9-CM codes for the Preventive Care Services at its discretion. These additions or revisions will be posted on SHPO s website. Services listed in the Preventive Care Services Guidelines table are covered with a $0.00 member cost share when received from a SHPO in-network provider. The guidelines should not replace clinical judgment or the needs of the individual patient. Publication History 01/01/2012: Original Document 2/3/12: Added V74.5 as an ICD-9 acceptable for reporting syphilis screening non-pregnant women Page 16

17 2/21/12: Added G0396 G0397 as an acceptable procedure code for reporting Alcohol Misuse Counseling 3/22/12: Added V76.47 as an acceptable dx code billed for reporting the Annual Wellness Visit. 4/25/12: Clarified and revised the Service & Description of the previously listed Annual Wellness Exam Assessment and Laboratory Services to, Annual Wellness/Physical Exam: Service includes either an Initial Preventative Physical Examination or an Annual Wellness Visit or a Comprehensive Preventive Exam or an Annual Physical, and any Laboratory Services performed: 7/1/12: Clarified description and reference language to include SACHDNC and Bright Futures. Added Behavioral/Psychosocial Assessments Added Developmental Assessments Clarified frequency and criteria for the Annual Wellness/Physical Exam, Hearing Loss Screening for Newborns, and in Visual Acuity Screening in Children Added as acceptable procedure code for reporting Visual Acuity Screening in Children and expanded the age to include up to age 21 years Expanded the age for Hearing Loss Screening for Newborns to include up to age 10 years 12/28/12: Summary of changes: BRCA Screening included S3818-S3823 and These are deleted as of 2013; the new codes added to BRCA Screening category are Corrected procedure code range for HIV Screening, removed G0434 as this is specific to a drug screening and not specific to HIV testing. Osteoporosis Screening included This code was deleted as of 2013; the new code range for this category is Lead Screening, new category to preventive build is identified by procedure code Tobacco Use Counseling category, removed HCPCS code S9075 as it expired in Syphilis Screening, removed diagnosis code V65.44, specific to HIV counseling and not syphilis. Women s build: Well Woman Visits, , with DX V22.0-V23.9 or , (already built in the preventive table); Gestational Diabetes (adding to existing range of ); Domestic Violence (No changes from 2012 Preventive); Contraception, 57170, 58565, , , , A4261, A4264, A4266, A4268, A4269, J1050 (J1051-J1056 deleted for 2013), J7300-J7307, S4981-S4989, S4993, 11981, 11983, and with DX V25.01-V25.03, V25.11, V25.13, V25.40-V25.5, Counseling: , with DX V V25.03, V25.11, V25.13, V25.40-V25.5; Breast Feeding A4281-A4286, E0602-E0603, S9443; HPV, ; HIV corrected code range G0432, G0433, and G0435. Remove G0434 not specific to HIV testing. This code is for drug screening; and, STD and G0445 (No changes from 2012 Preventive). Category language has been changed for the following: Blood Pressure Screening The USPSTF and HRSA recommend screening for high blood pressure in children ages 0-11 months, 1-11 years, adolescents 12-17, adults 18+ and older; Cervical Cancer Screening The USPSTF and HRSA strongly recommend screening for cervical cancer in females who have been sexually active and have a cervix; and, Dyslipidemia Screening (separate from Cholesterol Screening for adults). The HRSA recommends screening for children and adolescents that are at a higher risk of lipid disorders. Screening should be performed during a well-child visit, CPT code 80061, diagnoses V77.91, V81.2, frequency and criteria Children and Adolescents ages 1-17 years,. Took out age 0-5 years from the description for visual acuity, because it is actually 0-21 in accordance with Bright Future Recommendations. Added HRSA to the Recommendation column and to the script at the end of the table. 06/18/13: Added as an acceptable procedure code for reporting Hearing Loss Screening: Newborn Summary of Changes- Updated language to the Alcohol misuse Screening and Behavioral counseling category. Added code G0446 to Aspirin to prevent CVD in women category. Added new category - Aspirin to Prevent Preeclampsia in Pregnant Women. Added CPT to BRCA category. Updated recommendation language for Breast Cancer Prevention Medicine category. Updated the Cervical Cancer screening language and added new CPT codes. For the Colorectal Cancer Screening Category- Added CPT codes , removed as it expired on and was replaced by and G6022. Removed as it expired on , replaced with 45378, 45399, and G6021. For Dental Caries Chemoprevention: Preschool children category-updated recommendation language and added new CPT code For Depression Page 17

18 Screening- added CPT code For Gonorrhea screening- added G9228. For Healthy Diet Counseling, added new code G0473. Updated the Hep C Screening Category recommendation language to reflect is for all pregnant women AND all persons at high risk of infection. Added new category Hepatitis C Virus Infection Screening: Adults. For the HIV category, added the Bright Future recommendation of persons years of age get screened at least once and added CPT code Updated the recommendation language for the Intimate partner/domestic violence category- combine HRSA recommendations, Bright Future language all into the USPSTF language. Added new code G0473 to both Obesity screening categories. For Osteoporosis screening: women, CPT codes 77082, have been deleted. Updated the STI counseling recommendation language. Updated the language to the Tobacco Use counseling and CPT G9016. Added new category for Lung Cancer screening. Added new category for Congenital Heart Disease screening for Newborns. Updated recommendation for Dyslipidemia screening, an additional screening for 9-11 year olds per Bright Futures. Added the category for Hematocrit and Hemoglobin risk assessment. For the Behavioral/Psychosocial Assessment category, added cpt codes 96127, and G0444. For the Screening for Gestational Diabetes category, removed expired cpt code For Human Papillomavirus (HPV) Screening, removed as they expired on Added Replacement codes Added to Colorectal Cancer Screening Adding G6019, G6024-G6025, for Colorectal Cancer screening. Added G0468 to Annual Wellness Added A4267 to Contraceptive category Added G0464 to Colorectal Cancer Screening Category Added ICD-10 diagnosis codes to applicable categories. Also, removed the diagnosis codes from the Chlamydial infection screening per USPSTF, no diagnosis criteria restrictions. Page 18

USPSTF Grade A B Recommendations

USPSTF Grade A B Recommendations USPSTF Grade Recommendations bdominal aortic aneurysm screening: men The USPSTF recommends one-time screening for abdominal aortic aneurysm by ultrasonography in men aged 65 to 75 who have ever smoked.

More information

PREVENTIVE HEALTHCARE GUIDELINES INTRODUCTION

PREVENTIVE HEALTHCARE GUIDELINES INTRODUCTION PREVENTIVE HEALTHCARE GUIDELINES INTRODUCTION Health Plan of Nevada and Sierra Health and Life suggest that health plan members get certain screening tests, exams and shots to stay healthy. This document

More information

Procedure: 76700, 76705, 76770, 76775, G0389. Diagnosis: V15.82 Procedure: 80061, 82465, 83718, 83719, 83721, 84478 36415, 36416

Procedure: 76700, 76705, 76770, 76775, G0389. Diagnosis: V15.82 Procedure: 80061, 82465, 83718, 83719, 83721, 84478 36415, 36416 Page 1 of 12 2013 Confluence Health & Affiliated Providers Health Plan Preventive Medicine List Service Codes Notes Screening Services Abdominal Aortic Aneurysm Screening One time screening for men ages

More information

Preventive Services for Pregnancy SERVICE WHAT IS COVERED INTERVALS OF COVERAGE Anemia Screening Screening Annual screening for pregnant women

Preventive Services for Pregnancy SERVICE WHAT IS COVERED INTERVALS OF COVERAGE Anemia Screening Screening Annual screening for pregnant women Preventive Services for Pregnancy SERVICE WHAT IS COVERED INTERVALS OF COVERAGE Anemia Annual screening for pregnant women Bacteriuria For pregnant women at 12-16 weeks gestation or first prenatal visit

More information

ACA Mandates First Dollar Coverage for Preventive Services

ACA Mandates First Dollar Coverage for Preventive Services I N F O R M A T I O N U P D A T E May 2013 ACA Mandates First Dollar Coverage for Preventive Services The Affordable Care Act (ACA) mandates that, effective for Plan Years beginning on or after Sept. 23,

More information

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

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

More information

Preventive Care Coverage Wondering what preventive care your plan covers?

Preventive Care Coverage Wondering what preventive care your plan covers? STAYING WELL Regence BlueCross BlueShield of Oregon is an Independent Licensee of the Blue Cross and Blue Shield Association Preventive Care Coverage Wondering what preventive care your plan covers? Our

More information

Procedure Code(s): n/a This counseling service is included in a preventive care wellness examination or focused E&M visit.

Procedure Code(s): n/a This counseling service is included in a preventive care wellness examination or focused E&M visit. 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

More information

HEALTH CARE REFORM. Preventive Care. BlueCross BlueShield of South Carolina and BlueChoice HealthPlan of South Carolina

HEALTH CARE REFORM. Preventive Care. BlueCross BlueShield of South Carolina and BlueChoice HealthPlan of South Carolina HEALTH CARE REFORM Preventive Care BlueCross BlueShield of South Carolina and BlueChoice HealthPlan of South Carolina Preventive Care There was a time when an apple a day was the best preventive care advice

More information

Health care reform update

Health care reform update Preventive services coverage Kaiser Foundation Health Plan of the Northwest has always offered broad, affordable coverage options that encourage members to seek care before a health condition becomes serious.

More information

Preventive Care Guidelines

Preventive Care Guidelines Preventive Care Guidelines In accordance with Health Care Reform, for In-Network Providers, Non-Grandfathered Plans must provide benefits for and prohibit the imposition of cost-sharing requirements (including

More information

Health Care Reform: Using preventive care for a healthier life

Health Care Reform: Using preventive care for a healthier life HorizonBlue.com Health Care Reform: Using preventive care for a healthier life Horizon Blue Cross Blue Shield of New Jersey is committed to empowering our members with access to preventive services to

More information

Preventive care services for commercial members

Preventive care services for commercial members Preventive care services for commercial members This schedule is a reference tool for planning your preventive care and lists items/services covered under the Patient Protection and Affordable Care Act

More information

IN-NETWORK MEMBER PAYS. Out-of-Pocket Maximum (Includes a combination of deductible, copayments and coinsurance for health and pharmacy services)

IN-NETWORK MEMBER PAYS. Out-of-Pocket Maximum (Includes a combination of deductible, copayments and coinsurance for health and pharmacy services) HMO-OA-CNT-30-45-500-500D-13 HMO Open Access Contract Year Plan Benefit Summary This is a brief summary of benefits. Refer to your Membership Agreement for complete details on benefits, conditions, limitations

More information

Coverage for preventive care

Coverage for preventive care Coverage for preventive care Understanding your preventive care coverage Preventive care, like screenings and immunizations, helps you and your family stay healthier and can help lower your overall out-of-pocket

More information

Preventive Services at 100%

Preventive Services at 100% September 1, 2014 Update Preventive Care Services Covered Without Cost-sharing Without Copay, Coinsurance or Deductible The Affordable Care Act (ACA) requires non-grandfathered health plans and policies

More information

Prevents future health problems. You receive these services without having any specific symptoms.

Prevents future health problems. You receive these services without having any specific symptoms. Preventive Care To help you live the healthiest life possible, we offer free preventive services for most Network Health members. Please refer to your member materials, which you received when you enrolled

More information

Blue represents coding updates. 6/30/12 cancel 99408

Blue represents coding updates. 6/30/12 cancel 99408 An Independent Licensee of the Blue Cross and Blue Shield Association Preventive Care Services The following is a list of preventive services (HCP rider) along with the diagnoses and procedure codes that

More information

Preventive care covered with no cost sharing

Preventive care covered with no cost sharing Quality health plans & benefits Healthier living Financial well-being Intelligent solutions Preventive care covered with no cost sharing Get checkups, screenings, vaccines, prenatal care, contraceptives

More information

PREVENTIVE CARE SERVICES Detailed descriptions

PREVENTIVE CARE SERVICES Detailed descriptions PREVENTIVE CARE SERVICES Detailed descriptions How often and what kind of preventive care services you need depends upon your age, gender, health and family history. Not all items on this list are covered

More information

Preventive Care Guideline for Asymptomatic Low Risk Adults Age 18 through 64

Preventive Care Guideline for Asymptomatic Low Risk Adults Age 18 through 64 Preventive Care Guideline for Asymptomatic Low Risk Adults Age 18 through 64 1. BMI - Documented in patients medical record on an annual basis. Screen for obesity and offer intensive counseling and behavioral

More information

Understanding preventive care

Understanding preventive care Understanding preventive care We want you to be your healthiest. That s why the preventive services listed here are free for most members. What services are recommended? Know before you go. Preventive

More information

2015 Preventive Health Care Guidelines. Free preventive care to help you be your healthiest.

2015 Preventive Health Care Guidelines. Free preventive care to help you be your healthiest. 2015 Preventive Health Care Guidelines Free preventive care to help you be your healthiest. Guidelines may change throughout the year based on new research and recommendations. Get the most up-to-date

More information

Employer Sponsored Minimum Essential Coverage (MEC)

Employer Sponsored Minimum Essential Coverage (MEC) P.O. Box 129 Fort Mill, SC 29716 1-877-851-0906 SAMPLE EMPLOYEE SR 123 STREET RD Date: 05/01/2014 ANY, WI 12345 Group Number: M0001023 Employer Sponsored Minimum Essential Coverage (MEC) Your employer

More information

PREVENTIVE CARE SERVICES

PREVENTIVE CARE SERVICES PREVENTIVE CARE SERVICES CLINICAL POLICY Policy Number: PREVENTIVE 006.35 T0 Effective Date: September 1, 2015 Table of Contents CONDITIONS OF COVERAGE... COVERAGE RATIONALE DEFINITIONS... APPLICABLE CODES...

More information

Aetna Life Insurance Company

Aetna Life Insurance Company Aetna Life Insurance Company Hartford, Connecticut 06156 Amendment Policyholder: Group Policy No.: Effective Date: UNIVERSITY OF PENNSYLVANIA POSTDOCTORAL INSURANCE PLAN GP-861472 This Amendment is effective

More information

Take advantage of preventive care to help manage your health

Take advantage of preventive care to help manage your health Take advantage of preventive care to help manage your health Preventing disease and detecting health issues at an early stage, if they occur, are important to living a healthy life. Following these recommended

More information

PREVENTIVE CARE SERVICES

PREVENTIVE CARE SERVICES COVERAGE DETERMINATION GUIDELINE Guideline Number: CDG.016.08 Effective Date: September 1, 2015 PREVENTIVE CARE SERVICES Table of Contents COVERAGE RATIONALE... DEFINITIONS APPLICABLE CODES... REFERENCES...

More information

Preventive Health Services

Preventive Health Services understanding Preventive Health Services For the most current version of this document, visit www.wellwithbluemt.com or www.bcbsmt.com. Preventive health services include evidence-based screenings, immunizations,

More information

A B. C Plan C: It s Time to Choose Your 2015 Health Benefits. Plan A

A B. C Plan C: It s Time to Choose Your 2015 Health Benefits. Plan A HABLAMOS ESPANOL! Open Enrollment ends March 27. It s Time to Choose Your 2015 Health Benefits choose one... A B Plan A Wellness + Preventive $7.83 / week Plan B Plan A + Hospital Indemnity + Sickness,

More information

CIGNA S PREVENTIVE HEALTH COVERAGE

CIGNA S PREVENTIVE HEALTH COVERAGE A guide to CIGNA S PREVENTIVE HEALTH COVERAGE for health care professionals Introduction Cigna s preventive care coverage complies with the Patient Protection and Affordable Care Act (PPACA). Services

More information

Preventive Care Guideline for Asymptomatic Elderly Patients Age 65 and Over

Preventive Care Guideline for Asymptomatic Elderly Patients Age 65 and Over Preventive Care Guideline for Asymptomatic Elderly Patients Age 65 and Over 1. BMI - Documented in patients medical record on an annual basis up to age 74. Screen for obesity and offer counseling to encourage

More information

CIGNA S PREVENTIVE HEALTH COVERAGE for health care professionals

CIGNA S PREVENTIVE HEALTH COVERAGE for health care professionals A guide to CIGNA S PREVENTIVE HEALTH COVERAGE for health care professionals Introduction Cigna s preventive care coverage complies with the Patient Protection and Affordable Care Act (PPACA). Services

More information

BROKER GUIDE TO HEALTH CARE REFORM

BROKER GUIDE TO HEALTH CARE REFORM for groups 2 50 for groups of 51+ individual & family plans BROKER GUIDE TO HEALTH CARE REFORM January 2011 Inside: Understanding grandfathered status Benefit rule changes Preventive services summary Key

More information

A GUIDE TO CIGNA S PREVENTIVE HEALTH COVERAGE

A GUIDE TO CIGNA S PREVENTIVE HEALTH COVERAGE A GUIDE TO CIGNA S PREVENTIVE HEALTH COVERAGE For health care professionals Introduction Cigna s preventive care coverage complies with the Patient Protection and Affordable Care Act (PPACA). Services

More information

Preventive health guidelines As of May 2015

Preventive health guidelines As of May 2015 Preventive health guidelines As of May 2015 What is your plan for better health? Make this year your best year for wellness. Your health plan may help pay for tests to find disease early and routine wellness

More information

How To Know If Your Health Care Plan Covers Preventive Care At 100%

How To Know If Your Health Care Plan Covers Preventive Care At 100% A Guide to CIGNA S PREVENTIVE HEALTH COVERAGE for Health Care Professionals Introduction Cigna s preventive care coverage complies with the Patient Protection and Affordable Care Act (PPACA). Services

More information

Clinical Indicator Ages 19-29 Ages 30-39 Ages 40-49 Ages 50-64 Ages 65+ Frequency of visit as recommended by PCP

Clinical Indicator Ages 19-29 Ages 30-39 Ages 40-49 Ages 50-64 Ages 65+ Frequency of visit as recommended by PCP SCREENING EXAMINATION & COUNSELING UPMC Health Plan Clinical Indicator Ages 19-29 Ages 30-39 Ages 40-49 Ages 50-64 Ages 65+ Annually Physical Exam and Counseling 1 Blood Pressure 2 At each visit. At least

More information

Preventive health guidelines

Preventive health guidelines Preventive health guidelines As of May 2015 What is your plan for better health? Make this year your best year for wellness. Your health plan may help pay for tests to find disease early and routine wellness

More information

One time screening, repeat screening for those at risk

One time screening, repeat screening for those at risk 2015 Adult Male Preventive Health Guidelines Important Note Health Net s Preventive Health Guidelines provide Health Net members and practitioners with recommendations for preventive care services for

More information

Annually for adults ages 55 80 years with 30 pack/year smoking history and currently smoke or quit within the past 15 years Hepatitis B screening

Annually for adults ages 55 80 years with 30 pack/year smoking history and currently smoke or quit within the past 15 years Hepatitis B screening Preventive Care Schedule Effective January 1, 2016 Highmark Blue Cross Blue Shield Express Scripts The plan pays for preventive care only when given by a network provider. Certain vaccines are available

More information

This notice provides a safe harbor for preventive care benefits allowed to. be provided by a high deductible health plan (HDHP) without satisfying the

This notice provides a safe harbor for preventive care benefits allowed to. be provided by a high deductible health plan (HDHP) without satisfying the Part III - Administrative, Procedural, and Miscellaneous Notice 2004-23 PURPOSE This notice provides a safe harbor for preventive care benefits allowed to be provided by a high deductible health plan (HDHP)

More information

HEALTH SERVICES POLICY & PROCEDURE MANUAL. SUBJECT: Preventive Care EFFECTIVE DATE: September 2012 SUPERCEDES DATE: None PURPOSE POLICY PROCEDURE

HEALTH SERVICES POLICY & PROCEDURE MANUAL. SUBJECT: Preventive Care EFFECTIVE DATE: September 2012 SUPERCEDES DATE: None PURPOSE POLICY PROCEDURE HELTH SERVICES POLICY & PROCEDURE MNUL Page 1 of 6 SUJECT: Preventive Care EFFECTIVE DTE: September 2012 SUPERCEDES DTE: None PURPOSE To assure that DOP inmates have access to appropriate, proven, safe,

More information

Deductibles Type Value Network Out-of-Network Benefit. Individual $1,000 per covered person per contract year. Not Applicable

Deductibles Type Value Network Out-of-Network Benefit. Individual $1,000 per covered person per contract year. Not Applicable Consumers Mutual Value Network - Premier Schedule of Benefits Deductibles Type Value Network Out-of-Network Benefit Individual $1,000 per covered person per contract year. Not Applicable Family $2,000

More information

Illinois Insurance Facts Illinois Department of Insurance

Illinois Insurance Facts Illinois Department of Insurance Illinois Insurance Facts Illinois Department of Insurance Women s Health Care Issues Revised August 2012 Note: This information was developed to provide consumers with general information and guidance

More information

Affordable Care Act Opportunities for Community Health Workers

Affordable Care Act Opportunities for Community Health Workers Affordable Care Act Opportunities for Community Health Workers How Medicaid Preventive Services, Medicaid Health Homes, and State Innovation Models are Including Community Health Workers Amy Katzen and

More information

Preventive health guidelines As of May 2014

Preventive health guidelines As of May 2014 To learn more about your plan, please see anthem.com/ca. To learn more about vaccines, please see the Centers for Disease Control and Prevention (CDC) website: cdc.gov. Preventive health guidelines As

More information

Routine Preventive Services. Covered by Medicare 2012

Routine Preventive Services. Covered by Medicare 2012 Routine Preventive Services Covered by Medicare 2012 Brook Golshan, CPC, ACS-EM 2/20/2012 1 Preventive Services Covered by Medicare 2012 Covered by Medicare Part B: Original/Direct Medicare Most of the

More information

Important health care reform notice Women s preventive services covered with no member cost share

Important health care reform notice Women s preventive services covered with no member cost share Quality health plans & benefits Healthier living Financial well-being Intelligent solutions Important health care reform notice Women s preventive services covered with no member cost share www.aetna.com

More information

2015 External Employee Benefits

2015 External Employee Benefits 2015 External Employee Benefits Corporate Office 9995 N. Gate Parkway Suite 100 Jacksonville, FL 32246 (904) 338-9515 Fax (904) 338-9520 Nashville Office 3000 Meridian Blvd., Bldg. A Suite 160 Franklin,

More information

Preventive Health Guidelines

Preventive Health Guidelines Preventive Health Guidelines As of April 2010 What is your plan for better health? Make this year your best year for overall wellness. Your health benefits plan may cover early detection screenings and

More information

Preventive Care Recommendations THE BASIC FACTS

Preventive Care Recommendations THE BASIC FACTS Preventive Care Recommendations THE BASIC FACTS MULTIPLE SCLEROSIS Carlos Healey, diagnosed in 2001 The Three Most Common Eye Disorders in Multiple Sclerosis Blood Pressure & Pulse Height & Weight Complete

More information

HEALTHCARE REFORM PREVENTIVE MEDICATIONS LIST NO COST-SHARE PREVENTIVE MEDICATIONS

HEALTHCARE REFORM PREVENTIVE MEDICATIONS LIST NO COST-SHARE PREVENTIVE MEDICATIONS The Patient Protection and Affordable Care Act (PPACA), also know as HealthCare Reform, includes coverage for preventive health care services and certain medication with no out-of-pocket. The Department

More information

Preventive Services Explained

Preventive Services Explained Preventive Services Explained Medicare covers many preventive care services without charge. Most of these services have been recommended by the U.S. Preventive Services Task Force. However, which beneficiaries

More information

Questions & Answers on ACA Section 4106 Improving Access to Preventive Services for Eligible Adults in Medicaid

Questions & Answers on ACA Section 4106 Improving Access to Preventive Services for Eligible Adults in Medicaid Questions & Answers on ACA Section 4106 Improving Access to Preventive Services for Eligible Adults in Medicaid STATE PLAN AMENDMENT (SPA) Q1. Can a state submit a SPA to implement section 4106 at any

More information

2015-2016 Preventive Care Guidelines

2015-2016 Preventive Care Guidelines 2015-2016 Preventive Care Guidelines Table of Contents Introduction 2 Important Considerations 2 Preventive Health Guidelines for Children Age Birth to 17 Years. 4 Part I: Neonates (Birth to 1 Month) 4

More information

Preconception Clinical Care for Women Medical Conditions

Preconception Clinical Care for Women Medical Conditions Preconception Clinical Care for Women All women of reproductive age are candidates for preconception care; however, preconception care must be tailored to meet the needs of the individual. Given that preconception

More information

Hawaii Benchmarks Benefits under the Affordable Care Act (ACA)

Hawaii Benchmarks Benefits under the Affordable Care Act (ACA) Hawaii Benchmarks Benefits under the Affordable Care Act (ACA) 10/2012 Coverage for Newborn and Foster Children Coverage Outside the Provider Network Adult Routine Physical Exams Well-Baby and Well-Child

More information

The Guide to Clinical Preventive Services 2014

The Guide to Clinical Preventive Services 2014 The Guide to Clinical Preventive Services 2014 The clinical summaries in the Guide are abridged versions of recommendations from the U.S. Preventive Services Task Force (USPSTF). To view the full recommendation

More information

The Impact of the ACA and USPSTF Grade Change on Coverage of HIV Testing

The Impact of the ACA and USPSTF Grade Change on Coverage of HIV Testing The Impact of the ACA and USPSTF Grade Change on Coverage of HIV Testing Lindsey Dawson Public Policy Associate United States Conference on AIDS New Orleans, LA September 9, 2013 Coverage of Preventive

More information

Your Guide to Medicare s Preventive Services

Your Guide to Medicare s Preventive Services Your Guide to Medicare s Preventive Services C E N T E R S F O R M E D I C A R E & M E D I C A I D S E R V I C E S This is the official government booklet with important information about: What disease

More information

Health Maintenance Guidelines for Women

Health Maintenance Guidelines for Women Health Maintenance Guidelines for Women Customize your plan: These guidelines apply to healthy women in the general population. The right plan for your care may differ based on your medical history, family

More information

Summary of Cancer Prevention and Screening Benefits of the Affordable Care Act (ACA) in Kentucky for health professionals

Summary of Cancer Prevention and Screening Benefits of the Affordable Care Act (ACA) in Kentucky for health professionals Summary of Cancer Prevention and Screening Benefits of the Affordable Care Act (ACA) in Kentucky for health professionals Talk with patients about ü Potential benefits, harms, and unknowns of cancer ü

More information

Iowa s Maternal Health, Child Health and Family Planning Business Plan

Iowa s Maternal Health, Child Health and Family Planning Business Plan Iowa s Maternal Health, Child Health and Family Planning Business Plan CHILD HEALTH Who we are... A public-private partnership that... Promotes access to regular preventive health care services for children

More information

Included: Sample tweets/facebook posts Twitter Chat materials (sample questions/answers) Well- Woman Visit Infographic Social media images (posts,

Included: Sample tweets/facebook posts Twitter Chat materials (sample questions/answers) Well- Woman Visit Infographic Social media images (posts, Included: Sample tweets/facebook posts Twitter Chat materials (sample questions/answers) Well- Woman Visit Infographic Social media images (posts, cover photo, Twitter chat promo) National Women s Health

More information

WHAT GRANDFATHERED PLANS DO AND DON'T HAVE TO COVER. Judy Pfriemer, Chair, Employee Benefits jpfriem@astate4.edu HEALTH INSURANCE 2016???

WHAT GRANDFATHERED PLANS DO AND DON'T HAVE TO COVER. Judy Pfriemer, Chair, Employee Benefits jpfriem@astate4.edu HEALTH INSURANCE 2016??? Judy Pfriemer, Chair, Employee Benefits jpfriem@astate4.edu HEALTH INSURANCE 2016??? WHAT GRANDFATHERED PLANS DO AND DON'T HAVE TO COVER All health plans must End lifetime limits on coverage End arbitrary

More information

Tech Flex. March 2013, Issue III. Topics Covered in this Issue: Benefits: Payroll:

Tech Flex. March 2013, Issue III. Topics Covered in this Issue: Benefits: Payroll: March 2013, Issue III Tech Flex Topics Covered in this Issue: Benefits: Final Essential Health Benefits Guidance Released Guidance Provided on ACA Preventive Care Provisions Payroll: USCIS Releases Revised

More information

FEATURES NETWORK OUT-OF-NETWORK

FEATURES NETWORK OUT-OF-NETWORK Schedule of Benefits Employer: The Vanguard Group, Inc. ASA: 697478-A Issue Date: January 1, 2014 Effective Date: January 1, 2014 Schedule: 3B Booklet Base: 3 For: Choice POS II - 950 Option - Retirees

More information

please refer to our internet site, www.harvardpilgrim.org, or contact the Member Services

please refer to our internet site, www.harvardpilgrim.org, or contact the Member Services Schedule of s HPHC Insurance Company, Inc. THE HPHC INSURANCE COMPANY PPO PLAN MAINE ID: MD0000000750_F2 X This Schedule of s summarizes your benefits under The HPHC Insurance Company PPO Plan (the Plan)

More information

Screening for Cancer in Light of New Guidelines and Controversies. Christopher Celio, MD St. Jude Heritage Medical Group

Screening for Cancer in Light of New Guidelines and Controversies. Christopher Celio, MD St. Jude Heritage Medical Group Screening for Cancer in Light of New Guidelines and Controversies Christopher Celio, MD St. Jude Heritage Medical Group Screening Tests The 2 major objectives of a good screening program are: (1) detection

More information

PREVENTIVE MEDICINE AND SCREENING POLICY

PREVENTIVE MEDICINE AND SCREENING POLICY REIMBURSEMENT POLICY PREVENTIVE MEDICINE AND SCREENING POLICY Policy Number: ADMINISTRATIVE 238.13 T0 Effective Date: January 1, 2016 Table of Contents APPLICABLE LINES OF BUSINESS/PRODUCTS... APPLICATION...

More information

One of the most highly publicized provisions

One of the most highly publicized provisions Gut tmacher Policy Review GPR Fall 2012 Volume 15 Number 4 Beyond Contraception: The Overlooked Reproductive Health Benefits of Health Reform s Preventive Services Requirement By Adam Sonfield One of the

More information

MedStar Family Choice Benefits Summary District of Columbia- Healthy Families WHAT YOU GET WHO CAN GET THIS BENEFIT BENEFIT

MedStar Family Choice Benefits Summary District of Columbia- Healthy Families WHAT YOU GET WHO CAN GET THIS BENEFIT BENEFIT Primary Care Services Specialist Services Laboratory & X-ray Services Hospital Services Pharmacy Services (prescription drugs) Emergency Services Preventive, acute, and chronic health care Services generally

More information

AETNA HEALTH INC. (GEORGIA) CERTIFICATE OF COVERAGE

AETNA HEALTH INC. (GEORGIA) CERTIFICATE OF COVERAGE AETNA HEALTH INC. (GEORGIA) CERTIFICATE OF COVERAGE Plan Name: Silver HNOption 5200 100/50 O0140010116071 This Certificate of Coverage ("Certificate") is part of the Group Agreement ("Group Agreement")

More information

The Aetna Home Health Benefit Contract

The Aetna Home Health Benefit Contract INTRODUCTION TO YOUR INDIVIDUAL ADVANTAGE CONTRACT Welcome and thank you for choosing Aetna for your health benefits. We are pleased to provide you with this Contract. This Contract and other plan documents

More information

Dania Palanker Senior Health Policy Advisor National Women s Law Center December 5, 2012

Dania Palanker Senior Health Policy Advisor National Women s Law Center December 5, 2012 National Family Planning and Reproductive Health Association ACA Implementation: Health Insurance Exchanges Dania Palanker Senior Health Policy Advisor National Women s Law Center December 5, 2012 Why

More information

Examples of Technical Assistance & Materials Used by the Oregon Pediatric Improvement Partnership to Coach Practices on Using the 96110

Examples of Technical Assistance & Materials Used by the Oregon Pediatric Improvement Partnership to Coach Practices on Using the 96110 Examples of Technical Assistance & Materials Used by the Oregon Pediatric Improvement Partnership to Coach Practices on Using the 96110 List of Content OPIP Coaching Presentation: Using the 96110 Claim

More information

Policy Brief. New Affordable Care Act Insurance Regulations Improve Reproductive Health & Access. November 2010

Policy Brief. New Affordable Care Act Insurance Regulations Improve Reproductive Health & Access. November 2010 November 2010 Policy Brief New Affordable Care Act Insurance Regulations Improve Reproductive Health & Access Introduction The Patient Protection and Affordable Care Act (ACA), as amended by the Health

More information

BENEFIT PLAN. What Your Plan Covers and How Benefits are Paid. Appendix A. Prepared Exclusively for The Dow Chemical Company

BENEFIT PLAN. What Your Plan Covers and How Benefits are Paid. Appendix A. Prepared Exclusively for The Dow Chemical Company Appendix A BENEFIT PLAN Prepared Exclusively for The Dow Chemical Company What Your Plan Covers and How Benefits are Paid Choice POS II (MAP Plus Option 2 - High Deductible Health Plan (HDHP) with Prescription

More information

COVERAGE SCHEDULE. The following symbols are used to identify Maximum Benefit Levels, Limitations, and Exclusions:

COVERAGE SCHEDULE. The following symbols are used to identify Maximum Benefit Levels, Limitations, and Exclusions: Exhibit D-3 HMO 1000 Coverage Schedule ROCKY MOUNTAIN HEALTH PLANS GOOD HEALTH HMO $1000 DEDUCTIBLE / 75 PLAN EVIDENCE OF COVERAGE LARGE GROUP Underwritten by Rocky Mountain Health Maintenance Organization,

More information

Wellness Exam Coverage Highlights

Wellness Exam Coverage Highlights The following Medicare Advantage plans have updated coding procedures for 2013: AARP MedicareComplete UnitedHealthcare MedicareComplete UnitedHealthcare Dual Complete UnitedHealthcare MedicareDirect Wellness

More information

Cigna s Preventive. A guide to. for health care professionals. Preventive care services. Introduction

Cigna s Preventive. A guide to. for health care professionals. Preventive care services. Introduction A guide to Cigna s Preventive Health Coverage for health care professionals Introduction Cigna s preventive care coverage complies with the Patient Protection and Affordable Care Act (PPACA). Services

More information

California PCP Selected* Not Applicable

California PCP Selected* Not Applicable PLAN FEATURES Deductible (per calendar ) Member Coinsurance * Not Applicable ** Not Applicable Copay Maximum (per calendar ) $3,000 per Individual $6,000 per Family All member copays accumulate toward

More information

If you have a question about whether MedStar Family Choice covers certain health care, call MedStar Family Choice Member Services at 888-404-3549.

If you have a question about whether MedStar Family Choice covers certain health care, call MedStar Family Choice Member Services at 888-404-3549. Your Health Benefits Health services covered by MedStar Family Choice The list below shows the healthcare services and benefits for all MedStar Family Choice members. For some benefits, you have to be

More information

2014 Coding Procedures Update for Medicare Advantage

2014 Coding Procedures Update for Medicare Advantage 2014 Coding Procedures Update for Medicare Advantage The following Medicare Advantage plans have updated coding procedures for 2014: AARP MedicareComplete UnitedHealthcare MedicareComplete UnitedHealthcare

More information

A Strategic Plan for Improving Preconception Health and Health Care: Recommendations from the CDC Select Panel on Preconception Care

A Strategic Plan for Improving Preconception Health and Health Care: Recommendations from the CDC Select Panel on Preconception Care 1 A Strategic Plan for Improving Preconception Health and Health Care: Recommendations from the CDC Select Panel on Preconception Care Presentation by Kay A. Johnson, MPH, EdM Research Assistant Professor,

More information

PREVENTIVE SERVICES U.S. PREVENTIVE SERVICES TASK FORCE RECOMMENDATIONS

PREVENTIVE SERVICES U.S. PREVENTIVE SERVICES TASK FORCE RECOMMENDATIONS PREVENTIVE SERVICES U.S. PREVENTIVE SERVICES TASK FORCE RECOMMENDATIONS Policy The U.S. Departments of Health and Human Services (HHS), Labor and Treasury issued regulations under the Patient Protection

More information

Be Healthy. Be Healthy. Using Your Wellness Benefits. Helping You Stay Healthy. Wellness Benefits

Be Healthy. Be Healthy. Using Your Wellness Benefits. Helping You Stay Healthy. Wellness Benefits Be Healthy Wellness Benefits Be Healthy Using Your Wellness Benefits Helping You Stay Healthy Health Alliance emphasizes prevention through comprehensive wellness coverage. We support members throughout

More information

IS HERE OPEN ENROLLMENT EMPLOYEE BENEFITS TIME TO MAKE YOUR BENEFIT CHOICES. BAYADA Home Health Care Employee Benefits

IS HERE OPEN ENROLLMENT EMPLOYEE BENEFITS TIME TO MAKE YOUR BENEFIT CHOICES. BAYADA Home Health Care Employee Benefits 2015 OPEN ENROLLMENT IS HERE EMPLOYEE BENEFITS TIME TO MAKE YOUR BENEFIT CHOICES BAYADA Home Health Care values the contributions of our employees. In appreciation of your dedicated service, BAYADA Home

More information

2010 QARR QUICK REFERENCE GUIDE Adults

2010 QARR QUICK REFERENCE GUIDE Adults 2010 QARR QUICK REFERENCE GUIDE Adults ADULT MEASURES (19 through 64 years) GUIDELINE HEDIS COMPLIANT CPT/ICD9 CODES DOCUMENTATION TIPS Well Care Access to Ambulatory Care Ensure a preventive or other

More information

Health Profile for St. Louis City

Health Profile for St. Louis City Health Profile for St. Louis City The health indicators of St. Louis City show that the city has many health problems. To highlight a few, the city s rates of sexually transmitted diseases (i.e., HIV/AIDS,

More information

HUMANSERV1CES D f I A K T M t N T

HUMANSERV1CES D f I A K T M t N T State of New Mexico Medical Assistance Program Manual Supplement di HUMANSERV1CES D f I A K T M t N T DATE: February 18, 2014 NUMBER: 14-02 TO: FROM:(i SUBJECTS: I. BACKGROUND PROVIDERS PARTICIPATING IN

More information

Coverage of Medicaid Preventive Services for Adults A National Review

Coverage of Medicaid Preventive Services for Adults A National Review Coverage of Medicaid Preventive Services for Adults A National Review Sara Wilensky, JD, PhD The George Washington University Elizabeth Gray, JD The George Washington University Prepared for: The American

More information

HEDIS Code Quick Reference Guide Preventive/Ambulatory Services

HEDIS Code Quick Reference Guide Preventive/Ambulatory Services HEDIS Code Quick Reference Guide Preventive/Ambulatory Services Child/Adolescent Care Well-Child Visits in the First 15 Months of Life [Commercial, Medicaid] Well-Child Visits in the Third, Fourth, Fifth

More information

Texas Health Insurance Coverage for Prevention and Screening of Cancer, Cardiovascular Disease, and Diabetes

Texas Health Insurance Coverage for Prevention and Screening of Cancer, Cardiovascular Disease, and Diabetes Texas Health Insurance Coverage for Prevention and Screening of Cancer, Cardiovascular Disease, and Diabetes Phyllis Gingiss, Dr.P.H. Victoria Mosier, M.A. Sandra Coombs Khurram Shahzad, B.S. June 2007

More information

Billing Information - CPT and other Sources: Women s Health Screening

Billing Information - CPT and other Sources: Women s Health Screening Billing Information - CPT and other Sources: Women s Health Screening Getting Paid for Prevention Getting paid for preventive services depends on correct coding. Here's how to code four common types of

More information

ScreenWise. Breast, Cervical, and Hereditary Cancer Screenings OCTOBER 28, 2015

ScreenWise. Breast, Cervical, and Hereditary Cancer Screenings OCTOBER 28, 2015 ScreenWise Breast, Cervical, and Hereditary Cancer Screenings OCTOBER 28, 2015 ScreenWise Three programs working together to bring quality screening services to Oregon residents Why we all do this work

More information

2016 HEDIS & Quality Assurance Reporting Requirements Measures Provider Reference Guide

2016 HEDIS & Quality Assurance Reporting Requirements Measures Provider Reference Guide 2016 HEDIS & Quality Assurance Reporting Requirements Measures Provider Reference Guide HEDIS Measure: Test/Care Needed for Compliance Adult BMI Assessment Individuals ages 18-74 Documentation of BMI and

More information

Evidence-Based Practice for Public Health Identified Knowledge Domains of Public Health

Evidence-Based Practice for Public Health Identified Knowledge Domains of Public Health 1 Biostatistics Statistical Methods & Theory Evidence-Based Practice for Public Health Identified Knowledge Domains of Public Health General Public Health Epidemiology Risk Assessment Population-Based

More information

Section IX Special Needs & Case Management

Section IX Special Needs & Case Management Section IX Special Needs & Case Management Special Needs and Case Management 179 Integrated Care Management/Complex Case Management The Case Management/Care Coordination (CM/CC) program is a population-based

More information