Preventive Care Services Summary

Transcription

1 Preventive Care Services Summary Below is a list of preventive services along with the diagnoses and procedure codes that Community Health Options has determined to meet or exceed the requirements and recommendations issued by the Affordable Care Act (ACA) as of the date this was last updated. This document will be updated periodically to reflect the most up-to-date requirements. Services may be subject to Prior Approval or other Medical Management criteria. Preventive Health Services for Adults Abdominal Aortic Aneurysm Screening Alcohol Misuse screening and counseling Aspirin use to prevent cardiovascular disease for men and women of certain ages Blood Pressure screening for all adults Cholesterol screening for adults of certain ages or at higher risk Colorectal Cancer screening for adults over 50 Depression screening for adults Males only (with any history of smoking) 76770, 76775, G0389 Z87891, Z0000, Z PER LIFETIME Ages years One in a lifetime Age 18 and over 99408, Z0000, Z0001, Z1389 N/A N/A N/A Age 18 and over 80061, 82465, 83718, 83719, 83721, Z0000, Z0001, Z13220 All men age 35 and older Men ages 20 to 35 who have heart disease or risk factors for heart disease Women age 20 and older who have heart disease or risk factors for heart disease 50 and over 00810, 44388, 44389, 44392, 44393, 44394, 45300, 45305, 45308, 45309, 45315, 45320, 45330, 45331, 45332, 45333, 45338, 45339, 45341, 45342, 45378, 45380, 45381, 45383, 45384, 45385, 82270, 82272, 82274, 88304, 88305, G0104, G0105, G0106, G0120, G0121, G0122, G0328, G0464 Age 18 and over G Z0000, Z0001, Z120, Z1210, Z1211, Z1212, Z1213, Z1279, Z1289, Z129, Z800, Z809, Z8371, Z8379, Z8500, Z85038, Z85048, Z86010 Z1389 Revised 08/22/2016 1

2 Adults Diabetes (Type 2) screening for adults with high blood pressure Diet counseling for adults at higher risk for chronic disease HIV screening for everyone ages 15 to 65, and other ages at increased risk Immunization vaccines for adults--doses, recommended ages, and recommended populations vary: 82947, 82948, 82950, 82951, 82952, O24410, O24414, O24419, O24420, O24424, O24429, O24430, O24434, O24439, O99810, O99814, O99815, Z , 97803, 97804, G0270, G0271, Z724 S9470, 99401, 99403, , 86701, 86702, 86703, 87389, 87534, 87535, 87536, 87537, 87538, 87539, G0432, G0433, G , 90461, 90471, 90472, 90473, Hepatitis A 90632, 90633, 90634, Hepatitis B 90645, 90646, 90647, Herpes Zoster Human Papillomavirus 90649, Influenza (Flu Shot) , Measles, Mumps, Rubella Meningococcal 90644, 90733, Pneumococcal 90669, Tetanus, Diphtheria, Pertussis , 90714, 90715, Varicella Obesity screening and counseling for all adults Sexually Transmitted Infection (STI) prevention counseling for adults at higher risk Syphilis screening for all adults at higher risk Z0000, Z0001, Z00121, Z00129, Z , G , O0900, O0901, O0902, O0903, O0910, O0993, Z112, Z113, Z331, Z3400, Z3401, Z3402, Z3403, Z3480, Z3481, Revised 08/22/2016 2

3 Z3482, Z3483, Z3490, Z3491, Z3492, Z3493 Preventive Health Services for Adults Tobacco Use screening for all 99406, 99407, G0436, G0437 adults and cessation interventions for tobacco users Lung Cancer Screening Ages G0297, S8032 F17210, F17211, F17213, F17218, F17219, Z87891 Preventive Health Services for Women Anemia screening on a routine basis for pregnant women Pregnant females 85014, O0900, O0901, O0902, O0903, O0910, Breast Cancer Genetic Test Counseling (BRCA) for women at higher risk for breast cancer Breast Cancer Mammography screenings every 1 to 2 years for women over 40 Breast Cancer Chemoprevention counseling for women at higher risk Breastfeeding comprehensive support and counseling from trained providers, and access to breastfeeding supplies, for pregnant and nursing women Cervical Cancer screening for sexually active women Females Z0000, Z0001, Z1501, Z803, Z8041, Z8049, Z and over - ME 35 and over NH Females E/M CODE , , G0202, 77052, 77057, per year Z803, Z8041 Females S9443, E0603, E0604, A4281-A4286, Z391 Females , , 87623, G0101, G0123, G0124, G0141, G0143, G0144, G0145, G0147, G0148, Q0091 Z0000, Z0001, Z01411, Z01419, Z0142, Z1151, Z124 Revised 08/22/2016 3

4 Women Chlamydia Infection screening for younger women and other women at higher risk Contraception: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, as prescribed by a health care provider for women with reproductive capacity (not including abortifacient drugs). This does not apply to health plans sponsored by certain exempt religious employers. Domestic and interpersonal violence screening and counseling for all women Folic Acid supplements for women who may become pregnant Gestational diabetes screening for women 24 to 28 weeks pregnant and those at high risk of developing gestational diabetes Gonorrhea screening for all women at higher risk Females 86631, 86632, 87110, 87270, 87320, , Females Sterilization , 58600, 58605, 58611, 58615, 58670, 58671, A4264 Contraceptives , A4261, A4266, J7297, J7298, J7300, J7301, J7307, J1050, 11976, 58300, 58301, S4981, S4989 Anesthesia , 00940, 00942, 00950, 00952, 01960, 01961, 01965, 01966, 01967, Females COVERED UNDER E/M Females Pharmacy Vendor Z0000, Z0001, Z118 Z30011, Z30013, Z30014, Z30018, Z30019, Z30012, Z3009, Z30430, Z30432, Z30433, Z3040, Z3041, Z304031, Z3049, Z3042, Z308, Z309, Z302 Pregnant females 82947, 82948, 82950, 82951, 82952, O0900, O0901, O0902, O0903, O0910, Females 87590, 87591, 87592, O0900, O0901, O0902, O0903, O0910, O0993, Z112, Z113, Z331, Z3400, Z3401, Z3402, Z3403, Z3480, Z3481, Revised 08/22/2016 4

5 Women Hepatitis B screening for pregnant women at their first prenatal visit HIV screening and counseling for sexually active women Human Papillomavirus (HPV) DNA Test every 3 years for women with normal cytology results who are 30 or older Osteoporosis screening for women over age 60 depending on risk factors Rh Incompatibility screening for all pregnant women and follow-up testing for women at higher risk Sexually Transmitted Infections counseling for sexually active women Urinary tract or other infection screening for pregnant women Z3482, Z3483, Z3490, Z3491, Z3492, Z3493 Pregnant females 86706, 87340, 87341, 87515, 87516, O0900, O0901, O0902, O0903, O0910, Females 86689, 86701, 86702, 86703, 87389, 87534, 87535, 87536, 87537, 87538, 87539, Females 30 and older with normal cytology results G0432, G0433, G , Z0000, Z0001, Z01411, Z01419, Z0142, Z1151, Z124 Females 60 and over 76977, 77080, 77081, 77082, G0130 Z8262, Z0000, Z0001, Z13820 Females O0900, O0901, O0902, O0903, O0910, Females , G0445 Pregnant females O0900, O0901, O0902, O0903, O0910, 1 every 3 years Revised 08/22/2016 5

6 Women Well-woman visits to get recommended services for women under 65 Preventive Health Services for Children Autism screening for children at 18 and 24 months Behavioral assessments for children at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years. Cervical Dysplasia screening for sexually active females Depression screening for adolescents Developmental screening for children under age 17 Dyslipidemia screening for children at higher risk of lipid disorders at the following ages: 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years. Fluoride Chemoprevention supplements for children without fluoride in their water source Gonorrhea preventive medication for the eyes of all newborns Hearing screening for all newborns , , G0402, G0438, G0439 Applies To CPT Codes ICD Codes Notes 1-2 Years Z0000, Z0001, Z00121, Z00129, Z13220 Age ranges Included with e/m 1/1/15 = new code added Females , , 87623, G0101, G0123, G0124, G0141, G0143, G0144, G0145, G0147, G0148, Q0091 G Z0000, Z0001, Z01411, Z01419, Z0142, Z1151, Z124 Z years Z0000, Z0001, Z00121, Z00129, Z years 80061, 82465, 83718, 83719, 83721, Z0000, Z0001, Z00121, Z00129, Z13220 Covered Under E/M or Obtained At Pharmacy Pharmacy benefit or provided in hospital at birth 0-90 DAYS V5008, 92551, 92558, 92585, 92586, 92587, per year Revised 08/22/2016 6

7 Children Height, Weight and Body Mass Index measurements for children at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years. Hematocrit or Hemoglobin screening for children Hemoglobinopathies or sickle cell screening for newborns HIV screening for adolescents at higher risk Applies To CPT Codes ICD Codes Notes Age ranges included with e/m 0-90 DAYS 85014, Z0000, Z0001, Z00121, Z00129, Z DAYS S3850, 83020, 83021, 83030, 83033, , 86701, 86702, 86703, 87389, 87534, 87535, 87536, 87537, 87538, 87539, G0432, G0433, G DAYS 84437, **Hypothyroidism screening for newborns Immunization vaccines for 90460, 90461, 90471, 90472, 90473, children from birth to age 18 doses, recommended ages, and recommended populations vary: Diphtheria, Tetanus, Pertussis , 90714, 90715, Haemophilus influenzae type B Hepatitis A 90632, 90633, 90634, Hepatitis B 90645, 90646, 90647, Human Papillomavirus 90649, Inactivated Poliovirus Influenza (Flu Shot) , Measles, Mumps, Rubella Meningococcal 90644, 90733, Pneumococcal 90669, Rotavirus 90680, Varicella Iron supplements for children ages 6 to 12 months at risk for anemia Pharmacy Benefit Revised 08/22/2016 7

8 Children Lead screening for children at risk of exposure Medical History for all children throughout development at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years. Obesity screening and counseling Oral Health risk assessment for young children Ages: 0 to 11 months, 1 to 4 years, 5 to 10 years. Phenylketonuria (PKU) screening for this genetic disorder in newborns Sexually Transmitted Infection (STI) prevention counseling and screening for adolescents at higher risk Tuberculin testing for children at higher risk of tuberculosis at the following ages: 0 to 11 months, 1 to 4 years, 5 to 10 years, 11 to 14 years, 15 to 17 years. Vision screening for all children. Applies To CPT Codes ICD Codes Notes Z0000, Z0001, Z00121, Z00129, Z1388, Z77011 included with e/m Z0000, Z0001, Z00121, Z00129, Z1389 Pediatric Dental Program 0-1 years S3620, , G R7611, R7612, Z00121, Z00129, Z , Z0000, Z0001, Z00121, Z00129, Z13220 Revised 08/22/2016 8