EmblemHealth Preventive Care/Screening Services Exempt from Cost-Share
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- Bryan Bradford
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1 EmblemHealth Preventive Care/ Services Exempt from Cost-Share The Affordable Care Act (ACA) requires non-grandfathered health plans in the individual and group markets to cover certain preventive/screening care services received from in-network providers, in full, without member cost-sharing (i.e., without co-pay, deductible and/or co-insurance). In general, eligible services include preventive/screening care services which have received an A or B rating from the United States Preventive Services Task Force (USPSTF) or have been set forth in comprehensive guidelines supported by the Health Resources and Services Administration (HRSA), as well as immunizations recommended by the Advisory Committee on Immunization Practices (ACIP). For additional information about these guidelines and recommendation, please click on the link(s) below: Instructions to Providers for Coding Claims for ACA Mandated Preventive Care Services: In order to help EmblemHealth properly identify and accurately process claims for ACA-mandated preventive/screening care services, providers are asked to follow the coding guidelines and instructions below when submitting claims for these services to the following EmblemHealth companies: Group Health Incorporated ( GHI ), Health Insurance Plan of Greater New York ( HIP ) and HIP Insurance Company of New York ( HIPIC ). I) Annual Preventive Care Medical Evaluation A. Preventive Medicine Visits should be reported with the appropriate patient age and gender specific procedure code from the through AMA CPT Code range. B. The associated preventive/screening ICD-9/ ICD-10 diagnosis code (e.g., V70.0/ Z00.00, Z00.01) should be entered into the first claim diagnosis field. II) Preventive/ Colonoscopy A. Services provided by the in-network endoscopist, anesthesiologist and pathologist associated with an in-network preventive/screening colonoscopy are eligible for coverage without member cost-sharing. B. With the understanding that a preventive/screening colonoscopy may become diagnostic or therapeutic due to unforeseen findings, the AMA CPT Code that most accurately represents the procedure performed should be reported. C. The appropriate preventive/screening ICD-9/ ICD-10 diagnosis code (e.g., V76.51/ Z12.11) should be entered into the first claim diagnosis field. D. Anesthesia services should be reported with the appropriate preventive/screening ICD diagnosis code (e.g., V76.51 / Z12.11) entered into the first claim diagnosis field. While modifier 33 may be reported along with the anesthesia CPT code, it is not used in Medical Management Page 1 Adapted Jan. 2015
2 making preventive care benefit determinations; EmblemHealth considers the procedure and diagnosis codes when determining whether preventive care benefits apply. E. Pathology services should be reported with the appropriate screening ICD diagnosis code (e.g., V76.51/ Z12.11) entered into the first claim diagnosis field. III) All Other Preventive/ Services (e.g., Mammography, Lipid Profile) A. Eligible preventive screening services should be reported with the appropriate screening ICD diagnosis code (e.g., V76.10/ Z12.39, V70.0/ Z00.00, Z00.01) and entered into the first claim diagnosis field. Please note that for preventive/screening services provided after September 30, 2015, the appropriate ICD-10 diagnosis code will be required on submitted claims; ICD-9 diagnosis codes will not be recognized. EmblemHealth Preventive Care/ Services Table: Important Notes ACA-mandated preventive care/screening services are exempt from cost-sharing ONLY when performed within the health plan network. Coverage is subject to all terms, conditions, limitations and exclusions of the members EmblemHealth plan. Sections Click on the appropriate link to view the list of preventive services. General Preventive s and Counseling Specific s Immunizations Preventive Service Preventive Examination and Counseling Services Procedure Code Diagnosis Code ICD-10 Diagnosis Code Guidelines 99381, 99382, 99383, None None 99384, 99385, 99386, One 99387, 99391, 99392, procedure 99393, 99394, 99395, code/member/ 99396, year None None One procedure code/member/ year Comment Medical Management Page 2 Adapted Jan. 2015
3 99401, 99402, 99403, None None One procedure code/member/ year Preventive Service Abdominal Aortic Aneurysm (AAA) Procedure Code 76770, 76775, G0389 Alcohol 99408, 99409, G0396, G0397, G0442, G0443 Autism, Psychosocial/Behavioral and Developmental Diagnosis Codes ICD-10 Diagnosis Codes Guidelines V81.2 Z13.6 1x/lifetime Ages: years M V79.1 Z V20.2 Z00.121, Z Ages: 0 21 years Anemia (Infant) 85014, None None 1 x/year Ages: up to 1 year of age Anemia (Pregnant Women) 85014, 85018, 85025, V22.0, V22.1, V22.2, V23.0, V23.1, V23.2 V23.3, V23.41, V23.49, Z34.00,Z34.01,Z34.02,Z34.03, Z34.80, Z34.81,Z34.82, Z34.83, Z34.90,Z34.91,Z34.92,Z34.93, Z33.1,O09.00,O09.01, O09.02, O09.03, O09.10, O09.11, O09.12, 1 x/year Comment Medical Management Page 3 Adapted Jan. 2015
4 V23.5, V23.7, V23.81, V23.82, V23.83, V23.84, V23.85, V23.86, V23.89, V23.9 Anemia (General) V70.0, V70.8, V70.9, V20.2, V72.31 Breast Cancer, Genetic Testing (BRCA) Breast Feeding/Lactation Support 81211, 81212, 81213, 81214, 81215, 81216, , 99502, S9443 Breast Pumps E0602, E0604, E0603 Breast Pump Supplies A4282, A4283 None Breast Pump Supplies A4281, A4284, A4285, A4286 Chlamydia 86631, 86632, 87110, V16.41, V16.49, V16.40, V16.3 O09.13, O09.291, O09.40, O09.41, O09.42, O09.43, O09.211, O09.212, O09.213, O09.219, O09.292, O09.293, O09.299, O09.30, O09.31, O09.32, O09.33, O09.511, O09.512, O09.513, O09.519, O09.521, O09.522, O09.523, O09.529, O09.611, O09.612, O09.613, O09.619, O09.621, O09.622, O09.623, O09.629, O09.811, O09.812, O09.813, O09.819, O09.821, O09.822, O09.823, O09.829, O09.70, O09.71, O09.72, O09.73, O09.891, O09.892, O09.893, O09.899, O09.90, O09.91, O09.92, O09.93 Z00.00, Z00.01, Z00.5, Z00.70, Z00.71, Z00.8, Z00.121, Z00.129, Z01.411, Z Z80.3, Z80.49, Z80.41, Z80.49 F 1 x/year 1/per lifetime F None None Unlimited F None None 1 x/year F None 1 x/year F None None 1xyear F V74.5, V22.0, V22.1, Z34.00, Z34.01, Z34.02, Z34.03, Z34.80, Z34.81, Z34.82, Z34.83, Z34.90, Z34.91, Z34.92, Z34.93, Z33.1, O09.00, Medical Management Page 4 Adapted Jan. 2015
5 87140, 87270, 87320, 87490, 87491, 87492, 87800, 87801, V22.2, V23.0, V23.1, V23.2, V23.3, V23.41 V23.49, V23.5, V23.7, V23.81, V23.82, V23.83, V23.84, V23.85, V23.86, V23.89, V23.9, V73.88, V73.98,V72.31 O09.01, O09.02, O09.03, O09.10, O09.11, O09.12, O09.13, O09.291, O09.40, O09.41, O09.42, O09.43, O09.211, O09.212, O09.213, O09.219, O09.292, O09.293, O09.299, O09.30, O09.31, O09.32, O09.33, O09.511, O09.512, O09.513, O09.519, O09.521, O09.522, O09.523, O09.529, O09.611, O09.612, O09.613, O09.619, O09.621, O09.622, O09.623, O09.629, O09.811, O09.812, O09.813, O09.819, O09.821, O09.822, O09.823, O09.829, O09.70, O09.71, O09.72, O09.73, O09.891, O09.892, O09.893, O09.899, O09.90, O09.91, O09.92, O09.93, Z11.8, Z11.3, Z01.411, Z F Colon Cancer (Anesthesia and Ancillary Services) Colon Cancer (Procedures) V76.41, V76.50, V76.51, V , 44389, 44391, 44392, 44394, 45300, 45303, 45305, 45308, 45309, 45315, 45317, 45320, 45330, 45331, 45338, 45346, 45378, 45380, 45388, 45382, 45384, 45385, G6022 (deleted 01/01/16),, 74263, G6024 (deleted 01/01/16) V76.41, V76.50, V76.51, V16.0 Z80.0, Z12.12, Z12.10, Z12.11 Z80.0, Z12.12, Z12.10, Z x/year Ages: years 5x/year Once every 5 years Ages: years Medical Management Page 5 Adapted Jan. 2015
6 Colon Cancer (Procedures) G0104, G0105, G0106, G0120, G0121, G0122 K50.00, K50.011, K50.014, K50.018, K50.019, K50.10, K50.111, K50.114, K50.118, K50.119, K50.80, K50.811, K50.814, K50.818, K50.819, K50.90, K50.911, K50.914, K50.918, K50.919, K51.20, K51.211, K51.214, K51.218, K51.219, K51.30, K51.311, K51.314, K51.318, K51.319, K51.80, K51.811, K51.814, K51.818, K51.819, K51.90, K51.911, K51.914, K51.918, K51.919, K52.1, K52.89, K52.9, Z80.0, Z12.12, Z12.10, Z12.11 Once every 5 years Ages: years colonoscopy pre-procedure consultations Colon Cancer (Pathology) Colon Cancer (Stool For Occult Blood Lab Test) Contraceptive Counseling 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, V76.41, V76.50, V76.51, V , 82274, G , 99402, 99403, V76.41, V76.50, V76.51, V16.0 Z80.0, Z12.12, Z12.10, Z12.11 Z80.0, Z12.12, Z12.10, Z12.11 Z80.0, Z12.12, Z12.10, Z12.11 Once every 5 years Ages: years once every 5 years Ages: years once every 5 years Ages: years None None 1X year F Contraceptive Methods A4266, A4261 None None 4X/year Medical Management Page 6 Adapted Jan. 2015
7 F A4264 None None 1X/year F J7300,J7301, J7302 (deleted 01/01/16), J7306, J7307, S4989, S4981, J7297, J7298 V25.11, V25.13, V25.42, V45.51, V45.52, V25.43, V25.02, V25.09, V25.40, V25.49 Z30.430, Z30.433, Z30.431, Z97.5, Z30.013, Z30.014,Z30.018, Z30.019, Z30.49, Z30.09, Z30.40, Z X/year F J7303, J7304 V25.02, V25.40 Z30.013, Z30.014, Z30.018, Z30.019, Z X/year F J1050 V25.49 Z30.42, Z x/year F S4993 V25.01 Z X/year F 11976, 11980, 11981, 11982, V25.43, V25.5 Z X/year F 58300, V25.11, V25.12, V25.13, V25.42, Z30.430, Z30.432, Z30.433, Z30.431, T83.59xA, T83.6xxA 1X/year F Contraceptive Methods V25.12, V25.13, Z30.432, Z30.433,T83.59xA, T83.6xxA 1X/year F Dental Caries None None 2x/year Pediatrician(s) or PCP Medical Management Page 7 Adapted Jan. 2015
8 Prevention Ages: 0 5 years Depression G0444,96127 V79.0 Z13.89 Ages: 12 years and over Development Diabetes 82947, 82948, 82950, 82951, 82962, Diabetes : Gestational G0451 None None Ages: up to age , 82950, 82951, 82962, V77.1, V12.21 Z13.1, Z86.32 V22.0, V22.1, V22.2, V23.0, V23.1, V23.2, V23.3, V23.41, V23.49, V23.5, V23.7, V23.81, V23.82, V23.83, V23.84, V23.85, V23.86, V23.89, V23.9, , , V77.1, V12.21 O99.810, O24.410, O24.414, O24.419, Z34.00, Z34.01, Z34.02, Z34.03, Z34.80, Z34.81, Z34.82, Z34.83, Z34.90, Z34.91, Z34.92,Z34.93, Z33.1, O09.00, O09.01, O09.02, O09.03, O09.10, O09.11, O09.12, O09.13, O09.291, O09.40, O09.41, O09.42, O09.43, O09.211, O09.212, O09.213, O09.219, O09.292, O09.293, O09.299, O09.30, O09.31, O09.32, O09.33, O09.511, O09.512, O09.513, O09.519, O09.521, O09.522, O09.523, O09.529, O09.611, O09.612, O09.613, O09.619, O09.621, O09.622, O09.623, O09.629, O09.811, O09.812, O09.813, O09.819, O09.821, O09.822, O09.823, O09.829, O09.70, O09.71, O09.72, O09.73, O09.891, O09.892, O09.893, O09.899, O09.90, O09.91, O09.92, O09.93, Z13.1, Z x/year F providers only Dietary Counseling (Individuals Who are Overweight or Obese and Have Additional 97802, 97803, 97804, G0473 G0447, S9470, V85.30, V85.31, V85.32, V85.33, V85.34 V85.53, V85.54, V85.52, V85.35, E78.0, E78.1, E78.2, E78.3, E78.4, E78.5, Z68.30, Z68.31, Z68.32, Z68.33, Z68.34, Z68.35, Z68.36, Z68.37, Z68.38, Z68.39, Z68.41, Z68.42, Z68.43, Z68.44,Z68.45, Z68.52, Z68.53, Z68.54, E78.4, E Hours/year Medical Management Page 8 Adapted Jan. 2015
9 Cardiovascular Risk Factors) Gonorrhea 87590, 87591, 87592, Gynecological Exam 99384, 99385, 99386, 99387, 99394, 99395, 99396, Hearing 92551, 92552, 92553, 92558, 92568, 92585, 92586, G0270, G0271 V85.36, V85.37, V85.38, V85.39, V85.41, V85.42, V85.43, V85.44, V85.45, 272.0, 272.1, 272.2, 272.3, None None F V72.31 Z01.411, Z when provided by OB/Gyn or PCP F V20.2, V70.0, V72.12, Z00.121, Z00.129, Z00.00, Z00.01, Z01.12 Ages: 0 21 years Hepatitis B 87340, None None Hepatitis C 86803, G0472 V01.79,V69.8 Z20.5, Z20.6, Z20.828, Z72.89 Ages: 50+ HIV Testing 86689, 86701, 86702, 86703, 87389, 87390, 87391, 87534, 87535, 87536, 87537, 87538, None None 1xyear Medical Management Page 9 Adapted Jan. 2015
10 87539, 87806, S3645 HIV G0432, G0433, G0435, G0475 Human Papilloma Virus (HPV) 87623, 87624, V73.89, V65.44 Z11.4, Z71.7, Z11.59 Unlimited V73.81, V70.0, V72.31, V76.2 Z11.51, Z00.00, Z00.01, Z01.411, Z01.419, Z12.4 F Lead V15.86 Z Ages: 0-6 years Lipid 80061, 82465, 83718, 83719, 83721, V70.0, V70.8, V70.9, V20.2, V72.31, V77.91, V81.0, V81.1, V81.2 Z00.121, Z00.129, Z00.00, Z00.01, Z00.5, Z00.70, Z00.71, Z00.8, Z01.411, Z01.419, Z13.220, Z13.6 Lung Cancer S8032 V76.0, V15.82 Z87.891, Z12.2 Ages: 55 + Mammography 77051, 77052, 77057, G0202 Newborn : Hypothyroidism V76.10, V76.11, V76.12, V76.19 Z12.39, Z12.31 Ages: 40+ years F 84437, V77.0 Z13.29 Ages: 0-3 months Medical Management Page 10 Adapted Jan. 2015
11 Newborn : PKU Newborn : Sickle Cell Disease Obesity And Interventions Intensive behavioral therapy for cardiovascular disease V77.3 Z Ages: 0-3 months V78.2 Z13.0 Ages: 0-3 months 97802, 97803, 97804, G0447, G0473, S9470, G0270, G0271 Osteoporosis 76977, 77078, 77080, 77081, 77085, G0130 Pap Smear 87081, 87205, 88141, 88142, 88143, 88147, 88148, 88150, 88152, 88153, 88154, 88155, V85.30, V85.31, V85.32, V85.33, V85.34 V85.53, V85.54, V85.52, V85.35, V85.36, V85.37, V85.38, V85.39, V85.41, V85.42, V85.43, V85.44, V85.45, 272.0, 272.1, 272.2, 272.3, E78.0, E78.1, E78.2, E78.3, E78.4, E78.5, Z68.30, Z68.31, Z68.32, Z68.33, Z68.34, Z68.35, Z68.36, Z68.37, Z68.38, Z68.39, Z68.41, Z68.42, Z68.43, Z68.44, Z68.45, Z68.52, Z68.53, Z68.54 G0446 None None None None Every 23 months Ages: 60+ years F V70.0, V72.31, V76.2, V76.47, V15.89, V74.5, Z00.00, Z00.01, Z01.411, Z01.419, Z12.4, Z12.72, Z12.0, Z12.79, Z12.89, Z77.110, Z77.111, Z77.112, Z77.118, Z77.122, Z77.123, Z77.128, Z77.21, Z77.22, Z77.9, Z91.82, Z91.89, Z92.89,Z11.3, F Medical Management Page 11 Adapted Jan. 2015
12 Pregnancy, Bacteriuria 88164, 88165, 88166, 88167, 88174, 88175, G0101, G0123, G0124, G0141, G0143, G0144, G0145, G0147, G0148, Q , V22.0, V22.1, V22.2, V23.0, V23.1, V23.2, V23.3, V23.41, V23.42, V23.49, V23.5, V23.7, V23.81, V23.82, V23.83, V23.84, V23.85, V23.86, V23.89, V23.9 Pregnancy, Blood Count 85025, V22.0, V22.1, V22.2, V23.0, V23.1, V23.2, V23.3, V23.41, V23.42, V23.49, V23.5, V23.7, V23.81, V23.82, V23.83, V23.84, V23.85, V23.86,, V23.89, V23.9 Obstetric panel (includes HIV testing) Z34.00, Z34.01, Z34.02, Z34.03, Z34.80, Z34.81, Z34.82, Z34.83, Z34.90, Z34.91, Z34.92, Z34.93, Z33.1, O09.00, O09.01, O09.02, O09.03, O09.10, O09.11, O09.12, O09.13, O09.291, O09.40, O09.41, O09.42, O09.43, O09.211, O09.212, O09.213, O09.219, O09.292,O09.293, O09.299, O09.30, O09.31, O09.32, O09.33, O09.511, O09.512, O09.513, O09.519, O09.521, O09.522, O09.523, O09.529, O09.611, O09.612, O09.613, O09.619, O09.621, O09.622, O09.623, O09.629, O09.811, O09.812, O09.813, O09.819, O09.821, O09.822, O09.823, O09.829, O09.70, O09.71, O09.72, O09.73, O09.891, O09.892, O09.893, O09.899, O09.90, O09.91, O09.92, O09.93 Z34.00, Z34.01, Z34.02, Z34.03, Z34.80, Z34.81, Z34.82, Z34.83, Z34.90, Z34.91, Z34.92, Z34.93, Z33.1, O09.00, O09.01, O09.02, O09.03, O09.10, O09.11, O09.12, O09.13, O09.291, O09.40, O09.41, O09.42, O09.43, O09.211, O09.212, O09.213, O09.219, O09.292, O09.293, O09.299, O09.30, O09.31, O09.32, O09.33, O09.511, O09.512, O09.513, O09.519, O09.521, O09.522, O09.523, O09.529, O09.611, O09.612, O09.613, O09.619, O09.621, O09.622, O09.623, O09.629, O09.811, O09.812, O09.813, O09.819, O09.821, O09.822, O09.823, O09.829, O09.70, O09.71, O09.72, O09.73, O09.891, O09.892, O09.893, O09.899, O09.90, O09.91,O09.92,O Z34.00, Z34.01, Z34.02, Z34.03, Z34.80, Z34.81, Z34.82, Z34.83, Z34.90 Z34.91, Z34.92, Z34.93, Z33.1, O09.00, Unlimited F Unlimited F Medical Management Page 12 Adapted Jan. 2015
13 Pregnancy, Hepatitis B Pregnancy, Rh (D) Typing Pregnancy Panel Includes Hepb, Blood Count, Rh (D), 87340, V22.0, V22.1, V22.2, V23.0, V23.1, V23.2, V23.3, V23.41, V23.42, V23.49, V23.5, V23.7, V23.81, V23.82, V23.83, V23.84, V23.85, V23.86, V23.89, V V22.0, V22.1, V22.2, V23.0, V23.1, V23.2, V23.3, V23.41, V23.42, V23.49, V23.5, V23.7, V23.81, V23.82, V23.83, V23.84, V23.85, V23.86, V23.9, V V22.0, V22.1, V22.2, V23.0, V23.1, V23.2, O09.01, O09.02, O09.03, O09.10, O09.11, O09.12, O09.13, O09.291, O09.40, O09.41, O09.42, O09.43, O09.211, O09.212, O09.213, O09.219, O09.292, O09.293, O09.299, O09.30, O09.31, O09.32, O09.33, O09.511, O09.512, O09.513, O09.519, O09.521, O09.522, O09.523, O09.529, O09.611, O09.612, O09.613, O09.619, O09.621, O09.622, O09.623, O09.629, O09.811, O09.812, O09.813, O09.819, O09.821, O09.822, O09.823, O09.829, O09.70, O09.71, O09.72, O09.73, O09.891, O09.892, O09.893, O09.899, O09.90, O09.91, O09.92, O09.93 Z34.00, Z34.01, Z34.02, Z34.03, Z34.80, Z34.81, Z34.82, Z34.83, Z34.90 Z34.91, Z34.92, Z34.93, Z33.1, O09.00, O09.01, O09.02, O09.03, O09.10, O09.11, O09.12, O09.13, O09.291, O09.40, O09.41, O09.42, O09.43, O09.211, O09.212, O09.213, O09.219, O09.292, O09.293, O09.299, O09.30, O09.31, O09.32, O09.33, O09.511, O09.512, O09.513, O09.519, O09.521, O09.522, O09.523, O09.529, O09.611, O09.612, O09.613, O09.619, O09.621, O09.622, O09.623, O09.629, O09.811, O09.812, O09.813, O09.819, O09.821, O09.822, O09.823, O09.829, O09.70, O09.71, O09.72, O09.73, O09.891, O09.892, O09.893, O09.899, O09.90, O09.91, O09.92, O09.93 Z34.00, Z34.01, Z34.02, Z34.03, Z34.80, Z34.81, Z34.82, Z34.83, Z34.90, Z34.91, Z34.92, Z34.93, Z33.1, O09.00, O09.01, O09.02, O09.03, O09.10, O09.11, O09.12, O09.13, O09.291, O09.40, O09.41, O09.42, O09.43, O09.211, O09.212, O09.213, O09.219, O09.292, O09.293, O09.299, O09.30, O09.31, O09.32, O09.33, O09.511, O09.512, O09.513, O09.519, O09.521, O09.522, O09.523, O09.529, O09.611, O09.612, O09.613, O09.619, O09.621, O09.622, O09.623, O09.629, O09.811, O09.812, O09.813, O09.819, O09.821, O09.822, O09.823, O09.829, O09.70, O09.71, O09.72, O09.73, O09.891, O09.892, O09.893, O Z34.00, Z34.01, Z34.02, Z34.03, Z34.80, Z34.81, Z34.82, Z34.83, Z34.90, Z34.91, Z34.92, Z34.93, Z33.1, O09.00, O09.01, O09.02, O09.03, O09.10, O09.11, O09.12, F F Unlimited F Medical Management Page 13 Adapted Jan. 2015
14 Syphilis Sexually Transmitted Infections, Counseling Smoking Cessation (Individual and Group Counseling) V23.3, V23.41, V23.42, V23.49, V23.5, V23.7, V23.81, V23.82, V23.83, V23.84, V23.85, V23.86, V23.87, V23.89, V23.9 O09.13, O09.291, O09.40, O09.41, O09.42, O09.43, O09.211, O09.212, O09.213, O09.219, O09.292, O09.293, O09.299, O09.30, O09.31, O09.32, O09.33, O09.511, O09.512, O09.513, O09.519, O09.521, O09.522, O09.523, O09.529, O09.611, O09.612, O09.613, O09.619, O09.621, O09.622, O09.623, O09.629, O09.811, O09.812, O09.813, O09.819, O09.821, O09.822, O09.823, O09.829, O09.70, O09.71, O09.72, O09.73, O09.891, O09.892,O09.893,O09.899,O09.90, O09.91,O09.92,O09.93,O36.80x0 F G0445 None None 2xyear Ages: 12 years and over F 99406, 99407, G0436 (deleted effective 10/1/16), G0437(deleted effective 10/01/16) Sterilization 58565, 58600, 58605, 58611, 58615, 58670, 58671, (58340, 74740) Syphilis 86592, 86593, 86780, 87164, 87166, V15.82, Z87.891, F17.200, F17.201, F17.203, F17.208, F17.209, F17.210, F17.211, F17.213, F17.218, F17.219, F17.220, F17.221, F17.223, F17.228, F17.229, F17.290, F17.291, F17.293, F17.298, F17.299, T65.211A, T65.212A, T65.213A, T65.214A, T65.221A, T65.222A, T65.223A, T65.224A, T65.291A, T65.292A, T65.293A, T65.294A 8x/year V25.2, V26.51 Z30.2, Z per lifetime F None None TB Testing V20.2, V74.1 Z00.121, Z00.129, Z11.1 Medical Management Page 14 Adapted Jan. 2015
15 Venipuncture* 36415, V70.0, V70.8, V70.9, V20.2, V72.31, V20.0, V20.1, V20.31, V20.32 Vision in Children Z76.1, Z76.2, Z00.121, Z00.129, Z00.110, Z00.111, Z00.00, Z00.01, Z00.5, Z00.70, Z00.71, Z00.8, Z01.411, Z , V20.2, V72.0 Z00.121, Z00.129, Z01.00, Z01.01 Ages: 0-21 years Preventive Service Procedure Code Diagnosis Codes Guidelines Diptheria deleted 01/01/16 no replacement None Provider must adhere to FDA/CDC Diptheria, tetanus (DT) None Provider must adhere to FDA/CDC Diptheria, tetanus, acellular None Provider must adhere to FDA/CDC pertussis (DTaP) Diptheria, tetanus, acellular None Provider must adhere to FDA/CDC pertussis (Tdap), age 7 or older Diptheria, tetanus, acellular None Provider must adhere to FDA/CDC pertussis, Hepatitis B, polio (DtaP-HepB-IPV) Diptheria, tetanus, acellular pertussis, HIB (DTaP-HIB) deleted 01/01/16 no replacement None Provider must adhere to FDA/CDC Diptheria, tetanus, acellular pertussis, HIB, polio (DTaP-HIB- IPV) None Provider must adhere to FDA/CDC Diptheria, tetanus, pertussis HIB (DTP-HIB) deleted 01/01/16 no replacement None Provider must adhere to FDA/CDC Diptheria preservative free, tetanus (Td), age 7 or older 90714, None Provider must adhere to FDA/CDC Hepatitis A 90632, 90633, None Provider must adhere to FDA/CDC Hepatitis A/Hepatitis B Combo None Provider must adhere to FDA/CDC Medical Management Page 15 Adapted Jan. 2015
16 Hepatitis B 90739, 90740, 90743, 90744,, 90747, G0010 None Provider must adhere to FDA/CDC Hepatitis B/HIB Combo None Provider must adhere to FDA/CDC Herpes Zoster Vaccine None Unlimited Ages: 50+ years HIB (Hemophilus influenza b) deleted 01/01/16, 90646, deleted 01/01/ , None Provider must adhere to FDA/CDC HPV (Human Papillomavirus) Vaccine None Unlimited Age Band: 9-26 years None Unlimited Ages: 9-26 years None Unlimited Age Band: 9-26 years Influenza (flu) Vaccine 90630, 90653, 90654, 90655, 90656, 90657, 90658, 90661, 90672, 90685, 90686, 90688, 90673,G0008, Q2034, Q2035, Q2036, Q2037, Q2038,Q2039, 90660, 90662, None Provider must adhere to FDA/CDC Measles Immunization deleted 01/01/16 no replacement None Provider must adhere to FDA/CDC Measles-Mumps-Rubella (MMR) Virus Immunization None Provider must adhere to FDA/CDC Measles-Mumps-Rubella- Varcella (MMRV) None Provider must adhere to FDA/CDC Measles-Rubella Immunization deleted 01/01/16 no replacement None Provider must adhere to FDA/CDC Meningitis Vaccine 90733, None Provider must adhere to FDA/CDC Meningococcal Vaccine 90620, None Provider must adhere to FDA/CDC Meningitis-HIB Vaccine None Provider must adhere to FDA/CDC Mumps Immunization deleted 01/01/16 no replacement None Provider must adhere to FDA/CDC Medical Management Page 16 Adapted Jan. 2015
17 Pneumococcal Vaccine infant deleted 01/01/2016 no replacement None Provider must adhere to FDA/CDC Pneumococcal Vaccine, 13 valent 90670,G0009 None Provider must adhere to FDA/CDC Pneumococcal Vaccine Over age 2 and adult 90732, G0009 None Provider must adhere to FDA/CDC Poliomyelitis, inactivated (IPV) Immunization None Provider must adhere to FDA/CDC Poliovirus, oral (OPV) Immunization deleted 01/01/16 no replacement None Provider must adhere to FDA/CDC Rotavirus Vaccine 90680, None Provider must adhere to FDA/CDC Rubella Immunization deleted 01/01/16 no replacement None Provider must adhere to FDA/CDC Tetanus toxoid deleted 01/01/16 no replacement None Provider must adhere to FDA/CDC Varicella None Provider must adhere to FDA/CDC Medical Management Page 17 Adapted Jan. 2015
Procedure Code(s): n/a This counseling service is included in a preventive care wellness examination or focused E&M visit.
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Procedure: 76700, 76705, 76770, 76775, G0389. Diagnosis: V15.82 Procedure: 80061, 82465, 83718, 83719, 83721, 84478 36415, 36416
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