Procedure Code(s): n/a This counseling service is included in a preventive care wellness examination or focused E&M visit.
|
|
- Douglas Sullivan
- 6 years ago
- Views:
Transcription
1 Coding Summary for Providers NOTE THE FOLLOWING: The purpose of this document is to provide a quick reference of the applicable codes for UnitedHealthcare plans that cover preventive care services in accordance with the health care reform law. This resource does not replace or supersede the Preventive Care Services Coverage Determination Guideline. If there are any differences between this summary and the Preventive Care Services Coverage Determination Guideline, then the Coverage Determination Guideline takes precedence. Certain UnitedHealthcare plans do NOT use the following codes for preventive care benefits. This document does NOT apply to all UnitedHealthcare members. Please use your existing process for benefit verification such as looking up member benefit information at: UnitedHealthcareOnline.com Codes and (where listed below) are only covered as Preventive when done for a preventive lab procedure that requires a blood draw. See the Preventive Care Services Coverage Determination Guideline for complete coding instructions.. Each member s benefits are defined by his or her benefit plan documents, and any information in the following tables that is inconsistent with the applicable benefit plan documents does not constitute an additional benefit. Benefit adjudication is contingent upon accurate claims submission by the provider, including diagnosis, procedure, age and gender. See the Preventive Care Services Coverage Determination Guideline for a listing of applicable ICD-10 diagnosis codes effective on Oct. 1, 2015 Abdominal Aortic Aneurysm Anemia, Iron Deficiency Anemia Aspirin for the Prevention of Cardiovascular Disease (Counseling) 76700, 76705, 76770, 76775, G0389 Diagnosis Code(s): V , 85014, 85018, 36415, Diagnosis Code(s): Pregnancy (see list at end of section). This counseling service is included in a preventive care wellness examination or focused E&M visit. Bacteriuria Diagnosis Code(s): Pregnancy (see list at end of section). Behavioral Counseling in Primary Care to Promote a Healthy Diet , , G0270, G0271, G0446, G0447, S Diagnosis Code(s): V77.91, V15.82, V17.3, V17.49, , , V85.41 V85.45, 272.0, 272.1, 272.2, 272.3, 272.4, 401.0, 401.1, 401.9, , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , Males. Age Pregnant Pregnant Effective June 1, 2014 p. 1 of 9
2 Behavioral Counseling to Prevent Sexually Transmitted Infections Cervical Cancer, Pap Smear Chemoprevention of Breast Cancer (Counseling) Chlamydia Infection Cholesterol (Lipid Disorders ) , , , , , , , , , , , , , , , , , , , , , , , , , , 440.0, 440.1, , , , , , , , , , 440.8, 440.9, , , , , , , , , G0445 Code Group 1 (payable regardless of diagnosis code): G0101, G0123, G0124, G0141, G0143 G0145, G0147, G0148, Q0091, P3000, P3001 Code Group 2 (requires a diagnosis code from list below): , 88147, 88148, 88150, , , 88174, Diagnosis Code(s) Code Group 2: V70.0, V72.31, V72.32, V , 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99385, 99386, 99387, 99395, 99396, 99397, G0463 Diagnosis Code(s): V16.3, V16.41 Diagnosis code must be in primary position , 86632, 87110, 87270, 87320, 87490, 87491, 87492, 87801, 87810, 36415, Diagnosis Code(s): V70.0, V73.88, V73.98, V74.5, V75.9, OR Pregnancy (see list at end of section) , 82465, 83718, 83719, 83721, 84478, 36415, Diagnosis Code(s) (Required for all): V70.0 or V77.91 Diagnosis Codes for increased risk for coronary heart disease (for Men 20-34, and all Women 20 and up): V15.82, V17.3, V17.49, , , V85.41 V85.45, 401.0, 401.1, 401.9, , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , 440.0, 440.1, , , , , , , , , , 440.8, 440.9, , , , , , , , limits. All males age 35 and up. Males age if at increased risk for coronary heart disease. Females age 20 and up if at increased risk for coronary heart disease. NOTE: These will only pay as preventive if there is no prior history of a lipid disorder. Effective June 1, 2014 p. 2 of 9
3 Colorectal Cancer Counseling and Interventions to Prevent Tobacco Use Fecal Occult Blood Testing, Sigmoidoscopy, or Colonoscopy: Code Group 1 (Preventive regardless of diagnosis code): G0104, G0105, G0106, G0120, G0121, G0122, G0328 Code Group 2 (Preventive if billed in addition to a Code Group 1 code, OR if billed with one of the Diagnosis codes below): Procedure Codes: 44388, 44389, 44392, 44393, 44394, 45330, 45331, 45333, 45338, 45339, 45378, 45380, 45381, 45383, 45384, 45385, 82270, Diagnosis Code(s) (for Code Group 2): V16.0, V18.51, V18.59, V70.0, V76.41, V76.50, V76.51 Code Group 3 (Pathology): 88304, (These are Preventive if billed with one of the listed diagnosis code from Code Group 2 PLUS one of the Procedure code from Code Group 1 or 2): Computed Tomographic Colonography (Virtual Colonoscopy): (Preventive regardless of diagnosis code): , 99406, 99407, G0436, G0437 Diabetes 82947, 82948, 82950, 82951, 82952, 83036, 36415, Diagnosis Code(s): V70.0 or V77.1, PLUS ONE OF THE FOLLOWING HYPERTENSION CODES: 401.0, 401.1, 401.9, , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , See Expanded Women s Preventive Health table below for Gestational Diabetes codes. Genetic Counseling and Evaluation for BRCA Testing; and BRCA Lab Genetic Counseling and Evaluation: 96040, , , , , S0265, G0463 Diagnosis Code(s): V10.3, V10.43, V16.3, V16.41 Diagnosis code must be in primary position. BRCA Lab s: *Prior authorization requirements apply to BRCA lab screening Diagnosis Code(s): Family History: V16.3 and V16.41 This benefit only applies to patients with hypertension. NOTE: These will only pay as preventive if there is no prior history of diabetes. BRCA Lab s: Females age 18 and up with a family history of breast or ovarian cancer. Note: preventive benefits do not apply to BRCA Lab s for those that have a personal history, or current diagnosis, of breast and/or ovarian cancer. Effective June 1, 2014 p. 3 of 9
4 Gonorrhea 87590, 87591, 87592, 87801, Diagnosis Code(s): V70.0, V74.5, V75.9, OR Pregnancy (see list at end of section). Hepatitis B Virus Infection Hepatitis C Virus Infection (as of June 1, 2014) HIV Human Immunodeficiency Virus for Adolescents and Adults (Males and Females) 87340, 87341, 36415, Diagnosis Code(s): Pregnancy (see list at end of section) , 86804, 36415, Diagnosis Code(s): 042, , , , , , , , , 079.4, , , , 090.0, 090.1, 090.2, 090.3, , , , , 090.5, 090.6, 090.7, 090.9, 091.0, 091.1, 091.2, 091.3, 091.4, , , , , , 091.7, , , , 091.9, 092.0, 092.9, 093.0, 093.1, , , , , , , , , 093.9, 094.0, 094.1, 094.2, 094.3, , , , , , , , , 094.9, 095.0, 095.1, 095.2, 095.4, 095.5, 095.6, 095.7, 095.8, 095.9, 096, 097.0, 097.1, 097.9, 098.0, , , , , , , , , , 098.2, , , , , , , , , , , , , , , , , , , , 098.6, 098.7, , , , , , , , 099.0, 099.1, 099.2, 099.3, , , , , , , , , , , , 099.8, 099.9, , , , , , 131.8, 131.9, 286.0, 286.1, 286.2, 286.3, 286.4, , , , 286.6, 286.7, 286.9, , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , 555.0, 555.1, 555.2, 555.9, 556.0, 556.1, 556.2, 556.3, 556.4, 556.5, 556.8, 556.9, 585.3, 585.4, 585.5, 585.6, 608.4, 614.9, , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , 760.2, V01.6, V01.79, V02.7, V02.8, V07.39, V07.39, V08, V12.3, V15.85, V42.0, V42.1, V42.2, V42.3, V42.4, V42.5, V42.6, V42.81, V42.82, V42.83, V42.84, V42.89, V42.9, V45.11, V56.0, V56.31, V56.32, V56.8, V58.2, V59.01, V59.02, V59.09, V59.1, V59.2, V59.3, V59.4, V59.5, V59.6, V59.8, V59.9, V65.44, V69.2, V70.0, V71.5, V73.89, V73.99, V74.5, V75.9, V83.01, V83.02, V , 86701, 86702, 86703, G0432, G0433, G0435, S3645, 36415, Diagnosis Code(s): V02.9, V70.0, V73.89, V74.5, V75.9, OR Pregnancy (see list at end of section). Pregnant females. No age or frequency Immunizations Administration: 90460, 90461, 90471, 90472, 90473, 90474, G0008, G0009, G0010 Hepatitis A: 90632, 90633, 90634, 90636; Hemophilus influenza b: 90645, 90646, 90647, 90648; HPV: 90649, ; Influenza virus: 90654, 90655, 90656, 90657, 90658, 90660, 90661, 90662, 90664, 90666, 90667, 90668, 90672,90673, 90685, 90686, 90688, Q2034, Q2035, Q2036, Q2037, Q2038, Q2039; Effective June 1, 2014 p. 4 of 9 Preventive benefits are applied to immunizations that are within the ages listed (if any) in the FDA
5 Major Depressive Disorder in Children and Adolescents () Pneumococcal conjugate: 90669, 90670, S0195; Rotavirus: 90680, 90681; Dtap / Dtpap-IPV, Dtap-Hib-IPV / DTP / DT / Tetanus / Polio / TdaP/ Measles, Mumps, Rubella / MMR: 90696, 90698, 90700, 90702, 90703, 90704, 90705, 90706, 90707, 90708, 90710, 90713, 90714, 90715, 90719, 90720, 90721, 90723; Varicella: 90716; Pneumococcal: 90732; Meningococcal: 90733, 90734, 90644; Zoster: 90736; Hepatitis B: 90740, 90743, 90744, 90746, 90747, Revenue Code: , G0444 Diagnosis Code(s): V79.0 (Required for only) Also see section below: for Depression in Adults approval, or, ACIP recommendations. See the Preventive Care Services Coverage Determination Guideline for details. Metabolic Panel S3620, 82017, 82136, 82261, 82775, 83020, 83498, 83516, 84030, 84437, 84443, 36415, Age 0 90 days. Newborn s Hearing : V5008, 92551, 92558, Hypothyroidism : 84437, 84443, 36415, Phenylketonuria : S3620, 84030, 36415, Sickle Cell : S3850, 83020, 83021, 83030, 83033, 83051, 36415, Osteoporosis 76977, 77078, 77080, 77081, G0130 Diagnosis Code(s): V17.81, V70.0, V82.81 Prevention of Dental Caries in Preschool Children (Counseling) Primary Care Interventions to Promote Breastfeeding This service is included in the payment for a Preventive Care visit. This service is included in primary care or OB/GYN office visits. Also see Expanded Women s Preventive Care table below. Age 0 90 days. Prevention of Falls in Community-Dwelling Older Adults This service is included in the payment for a Preventive Care visit or focused E&M visit. Prostate Cancer Code Group 1: G0102, G0103, 36415, Code Group 2 (requires diagnosis code): 84152, 84153, 84154, 36415, Diagnosis Code(s): Code Group 1: Code Group 2: V16.42, V70.0, V76.44 Males, age 40 and up. Effective June 1, 2014 p. 5 of 9
6 RH Incompatibility 86901, 36415, Diagnosis Code(s): Pregnancy (see list at end of section). Pregnant females. Rubella By History of Vaccination or by Serology and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse for Depression in Adults History of Vaccination: No codes (included in exam) Serology: 86762, 36415, Diagnosis Code(s): V70.0 or V , 99409, G0442, G , G0444 Diagnosis Code(s): V79.0 (Required for only) Also see section above: Major Depressive Disorder in Children and Adolescents () for High Blood Pressure for Intimate Partner Violence This service is included in a preventive care wellness examination or focused E&M visit. This service is included in a preventive care wellness exam. for Obesity in Adults for Obesity in Children and Adolescents for Visual Impairment in Children 97802, 97803, 97804, 99401, 99402, 99403, 99404, G0446, G0447 Diagnosis Code(s) (Required for and ): BMI 30+ and Obesity: V85.30 V85.39, V85.41 V85.45, , , 97803, 97804, 99401, 99402, 99403, 99404, G0446, G0447 Diagnosis Code(s) (Required for and ): Obesity: , , Children less than age 5. Mammography G0202, 77052, 77057; Revenue code: 0403 Syphilis 86592, 86593, 36415, Diagnosis Code(s): V70.0, V74.5, V74.9, V75.9 OR Pregnancy (see list at end of section). Wellness Examinations (well baby, well child, well adult) G0402, G0438, G0439, G0445, S0610, S0612, S0613, , , , , Effective June 1, 2014 p. 6 of 9
7 Bright Futures: Anemia in Children Developmental/Autism Dyslipidemia Hearing Tests Lead TB Testing Cancer s: 85014, 85018, 36415, Diagnosis Code(s): V20.2, V20.31, V20.32, V Diagnosis Code(s): V , 82465, 83718, 83719, 83721, 84478, 36415, Diagnosis Code(s): V20.2, V , 92552, Diagnosis Code(s): V20.2, V , 36415, Diagnosis Code(s): V20.2, V , Diagnosis Code(s): , , V20.2. V74.1 CPT code is only payable as preventive with diagnosis code , or V74.1 Ages 24 months to 21 years. * The following is a list of preventive cancer screenings. These are also listed above. Cervical Cancer, Pap Smear Colorectal Cancer Code Group 1 (payable regardless of diagnosis code): G0101, G0123, G0124, G0141, G0143 G0145, G0147, G0148, Q0091, P3000, P3001 Code Group 2 (requires a diagnosis code from list below): , 88147, 88148, 88150, , , 88174, Diagnosis Code(s) Code Group 2: V70.0, V72.31, V72.32, V76.2 Fecal Occult Blood Testing, Sigmoidoscopy, or Colonoscopy: Code Group 1 (Preventive regardless of diagnosis code): G0104, G0105, G0106, G0120, G0121, G0122, G0328 Code Group 2 (Preventive if billed in addition to a Code Group 1 code, OR if billed with one of the Diagnosis codes below): Procedure Codes: 44388, 44389, 44392, 44393, 44394, 45330, 45331, 45333, 45338, 45339, 45378, 45380, 45381, 45383, 45384, 45385, 82270, Diagnosis Code(s) (for Code Group 2): V16.0, V18.51, V18.59, V70.0, V76.41, V76.50, V76.51 Code Group 3 (Pathology): 88304, (These are Preventive if billed with one of the listed diagnosis code from Code Group 2 PLUS one of the Procedure code from Code Group 1 or 2). Computed Tomographic Colonography (Virtual Colonoscopy) (Preventive regardless of diagnosis code): limits. Effective June 1, 2014 p. 7 of 9
8 Prostate Cancer Mammography Code Group 1: G0102, G0103, 36415, Code Group 2: (requires diagnosis code): 84152, 84153, 84154, 36415, Diagnosis Code(s): Code Group 1: Code Group 2: V16.42, V70.0, V76.44 G0202, 77052, 77057; Revenue code: 0403 Males, age 40 and up. Pregnancy Diagnosis Code List: The following codes are required only where indicated in the Preventive Care Services table (above), or in the Expanded Women s Preventive Care Services table (below): V22.0 V22.2 V23.0 V23.3, V23.41, V23.42, V23.49, V23.5, V23.7, V23.81 V23.86, V23.87, V23.89, V23.9 V91.00 V91.03, V91.09, V91.10 V91.12, V91.19 V91.22, V91.29, V91.90 V91.92, V91.99 Expanded Women s The following benefits are effective beginning the first plan year on or after 8/1/12. Code(s): Well-Woman Visits Also see Wellness Well-woman visits: See the Wellness Examinations section above. Examinations section Prenatal Office Visits: ; ; 99078, G0463 in the Preventive Care Prenatal Care Visits: 59425, Services table above. Global Obstetrical Codes*: 59400, 59510, 59610, * The routine, low-risk, prenatal visits portion of the Global Obstetrical code is covered as preventive. Diagnosis Code(s): See Pregnancy Diagnosis Code list above. for Gestational Diabetes 82947, 82948, 82950, 82951, 82952, 83036, 36415, Diagnosis Code(s): See Pregnancy Diagnosis Code list above. Pregnant females. Human Papillomavirus DNA Testing Counseling for Sexually Transmitted Infections Counseling and for Human Immune-deficiency Virus Contraceptive Methods (Including Diagnosis Code(s): V70.0, V72.31, V73.81, or V76.2 See the Wellness Examinations section of the Preventive Care Services table above. Counseling: See the Wellness Examinations section of the Preventive Care Services table above. Tests: See the HIV Human Immunodeficiency Virus for Adolescents and Adults section of the Preventive Services table above. Code Group 1: 58565, 58600, 58605, 58611, 58615, 58670, 58671, A4264, 57170, A4261, A4266, J7300, J7301 Effective June 1, 2014 p. 8 of 9 Females age 30 +
9 Expanded Women s The following benefits are effective beginning the first plan year on or after 8/1/12. Code(s): Sterilizations) NOTE: Certain health plans may qualify for an exemption from covering contraceptive methods and sterilizations. Breastfeeding Support, Supplies, and Counseling and Counseling for Interpersonal and Domestic Violence Code Group 2: (requires a diagnosis from list below): 11976, 11981, 11982, 11983, 58300, 58301, J1050, J7302, J7306, J7307, S4981, S4989 Code Group 2a: (Preventive when billed with J1050 AND one of the Code Group 2 Diagnosis Codes below): Code Group 2 Diagnosis Code(s): V25.01, V25.02, V25.03, V25.09, V25.11, V25.12, V25.13, V25.40, V25.41, V25.42, V25.43, V25.49, V25.5, V25.8, V25.9 Code Group 3: (requires diagnosis V25.2): 00851, 00940, 00942, 00950, 00952, 01960, 01961, 01965, 01966, 01967, Code Group 3 Diagnosis Code: V25.2 Code Group 4: (Tubal ligation followup hysterosalpingogram): 58340, Code Group 4 Diagnosis Code: V26.51 Support and Counseling: S9443, , , (Also see the codes in the Wellness Examinations section of the Preventive Care Services table above.) Diagnosis Code(s): V24.1 (Code V24.1 is required for , , and ) Equipment & Supplies: (Purchase of a personal-use electric breast pump) E0603, A4281, A4282, A4283, A4284, A4285, A4286 Diagnosis Code(s): Pregnancy diagnosis (see list above) or V24.1 See the Wellness Examinations section of the Preventive Care Services table above. Diagnosis Code(s): See the Wellness Examinations section of the Preventive Care Services table above. One pump per birth. N/A Effective June 1, 2014 p. 9 of 9
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
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
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
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
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
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
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
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.
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,
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
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
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
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
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
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
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
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
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
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.
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
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,
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...
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
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...
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
PREVENTIVE CARE SERVICES GUIDELINES
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
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
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
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
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
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
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,
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
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
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
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
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
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)
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,
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
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
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
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
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
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
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
Coverage Overview. Preventive Care. For complete details, please call Aetna at 1-800-423-9752.
Coverage Overview The following charts highlight our most commonly used services under the Progressive medical plans administered by Aetna. Please be aware that certain covered services are subject to
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
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
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
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
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
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
99381, 99382: Initial preventive medicine evaluation 99391, 99392: Periodic preventive medicine re-evaluation
Age Birth - 24 months 2-11 s M/ M/ Preventive medicine, re-, or office visit/ 8 visits within the first 24 months of life (As part of preventive medicine or re-, Hemoglobin, hematocrit, or CBC for those
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
AETNA BETTER HEALTH OF MISSOURI
Aetna Better Health of Missouri 10 South Broadway, Suite 1200 St. Louis, MO 63102 800-566-6444 AETNA BETTER HEALTH OF MISSOURI HEDIS Quick Reference Billing Guide 2014 Diagnosis and/or procedure codes
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
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
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
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
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,
Carnegie Mellon University Policy #02424 Benefits at a Glance Effective Date: January 1, 2014
Carnegie Mellon University is offering Medical, Dental, Vision, Pharmacy, Medical Evacuation and Repatriation benefits through Cigna Global Health Benefits to our employees. This comprehensive international
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
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
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
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
AETNA HEALTH INC. (Arizona) CERTIFICATE OF COVERAGE
Plan Name: AZ Gold HMO 25/50/500 AZN1010010116071 AETNA HEALTH INC. (Arizona) CERTIFICATE OF COVERAGE This Certificate of Coverage ("Certificate") is part of the Group Agreement ("Group Agreement") between
PARTICIPATING PROVIDERS / REFERRED Deductible (per calendar year)
Your HMO Plan Primary Care Physician - You choose a Primary Care Physician. The Aetna HMO Deductible provider network gives you access to a wide selection of Primary Care Physicians ( PCP's) and Specialists
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
MEDICARE PREVENTIVE PHYSICAL EXAM
MEDICARE PREVENTIVE PHYSICAL EXAM l Initial Preventive Physical Exam (Welcome to Medicare Physical) l Initial annual wellness visit l Subsequent annual wellness visit l Other Patient name Medical record
Research Triangle Institute Policy #04806A Benefits at a Glance Effective Date: January 1, 2013
Research Triangle Institute Research Triangle Institute is offering Medical, Dental, Vision, Pharmacy, Medical Evacuation and Repatriation, and Long Term Disability> benefits through Cigna Global Health
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
Benefits at a Glance: Visa Inc. Policy Number: 00784A
Benefits at a Glance: Visa Inc. Policy Number: 00784A Visa Inc. Benefits at a Glance Policy #00784A Effective Date: January 1, 2016 Visa Inc. offers Medical, Pharmacy, Vision, Dental and Medical Evacuation
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
AETNA HEALTH INC. (Arizona) CERTIFICATE OF COVERAGE
AETNA HEALTH INC. (Arizona) CERTIFICATE OF COVERAGE Plan Name: AZ Silver HNOption 1500 70/50 AZO0010010116071 This Certificate of Coverage ("Certificate") is part of the Group Agreement ("Group Agreement")
IHS Clinical Reporting System
RESOURCE AND PATIENT MANAGEMENT SYSTEM IHS Clinical Reporting System (BGP) Version 12.1 Office of Information Technology (OIT) Division of Information Resource Management Albuquerque, New Mexico Revision
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")
Carnegie Mellon University Benefits at a Glance Policy #02424A Effective Date: 1/1/2015
Carnegie Mellon University Benefits at a Glance Policy #02424A Effective Date: 1/1/2015 Carnegie Mellon University offers Medical, Pharmacy, Medical Evacuation and Repatriation, Vision, and Dental benefits
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
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
MEASURING CARE QUALITY
MEASURING CARE QUALITY Region November 2015 For Clinical Effectiveness of Care Measures of Performance From: Healthcare Effectiveness Data and Information Set (HEDIS ) HEDIS is a set of standardized performance
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
PASSPORT TO WOMEN S HEALTH
PASSPORT TO WOMEN S HEALTH Introduction W omen are extraordinary. Daughters, sisters, mothers, aunts, cousins, friends, wives. Saint John s Health Center recognizes the importance of women and that women
Limited Benefits & Self-Funded Minimum Essential Coverage (MEC) Enrollment Form
Limited Benefits & Self-Funded Minimum Essential Coverage (MEC) Enrollment Form Any person who knowingly, and with intent to injure, defraud or deceive any insurer, makes any claim for the proceeds of
Immunization Information for Blinn College Students
1 Immunization Information for Blinn College Students *Important Information Regarding the Bacterial Meningitis Vaccine* The State passed Senate Bill 1107 in 2011 and recently Senate Bill 62 in 2013, which
SUMMARY TABLE OF MEASURE CHANGES
Summary Table of Measure 1 SUMMARY TABLE OF MEASURE CHANGES Guidelines for Physician Measurement Effectiveness of Preventive Care Guidelines for Physician Effectiveness of Care Adult BMI Assessment Weight
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,
5 ways to reduce healthcare costs in the Coastal Bend
5 ways to reduce healthcare costs in the Coastal Bend Understanding Your Health Coverage to Get the Most from It WRITTEN BY: William Heavin, LUTCF, ACBC, LRA Victor Lehman The New Era of Healthcare This
Healthy People in Healthy Communities
Healthy People 2020 Alaska Hawaii American Samoa U.S. Virgin Islands Federated States of Micronesia Republic of Marshall Islands Commonwealth of Northern Mariana Islands Puerto Rico Palau Guam www.healthypeople.gov
Healthy People in Healthy Communities
Healthy People 2020 Alaska Hawaii American Samoa U.S. Virgin Islands Federated States of Micronesia Republic of Marshall Islands Commonwealth of Northern Mariana Islands Puerto Rico Palau Guam www.healthypeople.gov
Limited Benefits & Self-Funded Minimum Essential Coverage (MEC) Enrollment Form
Limited Benefits & Self-Funded Minimum Essential Coverage (MEC) Enrollment Form Any person who knowingly, and with intent to injure, defraud or deceive any insurer, makes any claim for the proceeds of
DynCorp International LLC US Expat Plan Benefits at a Glance Policy # 00257A Effective Date: January 1, 2015
DynCorp LLC US Expat Plan Benefits at a Glance Policy # 00257A Effective Date: January 1, 2015 DynCorp LLC is offering Medical, Dental, Vision, Pharmacy, Medical Evacuation and Repatriation benefits to
PROGRAM ASSISTANCE LETTER
PROGRAM ASSISTANCE LETTER DOCUMENT NUMBER: 2014-01 DATE: December 13, 2013 DOCUMENT TITLE: Approved Uniform Data System Changes for Calendar Year 2014 TO: Health Centers Primary Care Associations Primary
Public health functions to be exercised by NHS England. Variation to the 2013-14 agreement
Public health functions to be exercised by NHS England Variation to the 2013-14 agreement April 2013 You may re-use the text of this document (not including logos) free of charge in any format or medium,
Clinical Quality Measure Crosswalk: HEDIS, Meaningful Use, PQRS, PCMH, Beacon, 10 SOW
Clinical Crosswalk: HEDIS, Meaningful Use, PQRS, PCMH, Beacon, 10 SOW NQF 0105 PQRS 9 NQF 0002 PQRS 66 Antidepressant Medication Management Appropriate Testing for Children with Pharyngitis (2-18 years)
Things You Need to Know About the Affordable Care Act
9 Things You Need to Know About the Affordable Care Act Find out what health care reform means for you 1 9 Things You Need to Know About the Affordable Care Act Health care reform law is reinventing the
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
Care Gap Care Reminder Description Reference 900-2035-1210. Cardiovascular Persistence of Beta- Blocker Treatment After a Heart Attack (PBH)
Below is a list of the current Care Reminders shown in the Patient Care Summary Clinical Messaging section of the Availity web portal. These Florida Blue clinical alerts are based on claim data and are
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
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