Preventive Medicine: Coding and Billing Information

This is an educational tool, not meant to be viewed as coding or billing guidelines.

Preventive Medicine Coding and Billing Info

Telehealth applicable codes will be indicated with a phone icon. 

Click on the topic you’re interested in below to view the information for it. You can also scroll down to review all topics. To see published recommendations according to population/grade per U.S. Preventive Services Task Force click here

General Codes 

Alcohol Misuse Screening & Counseling 

Screening for Anemia

Annual Wellness Visit 

Bone Mass Measurements

Breast Cancer Genetic Screening

Breastfeeding Supplies

Cardiovascular Disease Screening Tests

Cervical Dysplasia Screening

Colorectal Cancer Screening

Contraceptive Methods

Counseling to Prevent 
Tobacco Use 

Dental Caries in Children

Depression Screening 

Diabetes Screening

Diabetes Self-Management 
Training 

Therapy for Fall Prevention

Glaucoma Screening

HBV Vaccine & Administration

Hepatitis C Virus Screening

HIV Screening

HPV Vaccine and Screening

Influenza Virus Vaccine & Administration

Initial Preventive Physical Examination

Medical Nutrition Therapy and CVD/Obesity Prevention

Lung Cancer Screening

Newborn Screenings/Tests

Pneumococcal Vaccine & Administration

Prostate Cancer Screening

Screening for STIs and HIBC to Prevent STIs

Screening Mammography

Screening Pap Tests

Screening Gynecological Examination

Ultrasound Screening for AAA

Visual Acuity Screening

Modifier 33

References

Additional Links and Resources

 

 

Plan networks and government plans are required to cover preventive services as required by the Affordable Care Act (ACA) at no cost to the patient. This covers numerous screenings, counseling and well visits to prevent illness, disease and health problems. Services are based on age, gender, and other health factors. This does not include diagnostic testing as this is not considered preventive. Preventive services must be performed by a covered provider, in-network and may be used to develop a wellness plan to keep the patient healthy.

This page was created from a need to have all of the information in one place to accommodate Payers, Providers, Researchers, and others, suggestions and feedback are always welcome, please send it to us at Support@Findacode.com. The information covered on this page is informational only and not meant to be all-inclusive, always verify coverage with your payer.

For more information about the Affordable Care Act visit HHS.gov

 

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General Procedures 

Procedure Codes 
36415: Collection of venous blood by venipuncture 
90471: Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid) 
90472: Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure) 
90460: Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first or only component of each vaccine or toxoid administered 
90461: Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; each additional vaccine or toxoid component administered (List separately in addition to code for primary procedure) 
99000: Handling and/or conveyance of specimen for transfer from the office to a laboratory 
99201: Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self-limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family. 
99202: Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 20 minutes are spent face-to-face with the patient and/or family. 
99203: Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Typically, 30 minutes are spent face-to-face with the patient and/or family. 
99204: Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 45 minutes are spent face-to-face with the patient and/or family. 
99205: Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 60 minutes are spent face-to-face with the patient and/or family. 
99211: Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal. Typically, 5 minutes are spent performing or supervising these services. 
99212: Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self-limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family. 
99213: Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 15 minutes are spent face-to-face with the patient and/or family. 
99214: Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 25 minutes are spent face-to-face with the patient and/or family.

 

 

99215: Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 40 minutes are spent face-to-face with the patient and/or family. 
99381: Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; infant (age younger than 1 year) 
99382: Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; early childhood (age 1 through 4 years) 
99383: Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; late childhood (age 5 through 11 years) 
99384: Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; adolescent (age 12 through 17 years) 
99385: Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 18-39 years 
99386: Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 40-64 years 
99387: Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 65 years and older 
99391: Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; infant (age younger than 1 year) 
99392: Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; early childhood (age 1 through 4 years) 
99393: Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; late childhood (age 5 through 11 years) 
99394: Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; adolescent (age 12 through 17 years) 
99395: Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 18-39 years 
99396: Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 40-64 years 
99397: Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 65 years and older 
99401: Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15 minutes 
99402: Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 30 minutes 
99403: Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 45 minutes 
99404: Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 60 minutes

ICD-10-CM Codes 
36415, 99000, 99401-99404, 99201-99215: No specific diagnoses
99381-99397: Z00.00, Z00.01, Z00.110, Z00.111, Z00.121-Z00.129, Z01.411- Z01.419, Z02.0, Z02.2, Z02.4, Z02.82 
99395-99397: Z11.8, Z12.39, Z12.4, Z12.5
90461-90461, 90471-90472: Z23

Frequency 
No frequency guidelines specified

 

Additional Information 
36415

  • Only counted as preventive when used with a preventive lab

99401-99404

  • Only used when a preventive service, normally included in another service, is performed by itself (e.g., breastfeeding counseling, obesity screening and counseling, skin cancer prevention).
  • Modifier 33 is not required as the CPT codes themselves indicate they are for preventive services.
  • Not covered by Medicare

99201-99215

  • Only for use when there is no code that is more appropriate or that covers the service provided.
  • Modifier 33 needs to be added as these codes are not specified as preventive alone, and clear documentation showing the preventive service provided that doesn’t support a different, more appropriate code.
  • When preventive services are provided on the same day or encounter as medical services they can be included in the visit code, but can be billed separately in some cases. If you decide to bill them separately there must be clear documentation that both services were extensive enough to warrant payment for both.

99381-99397

  • Not covered by Medicare
  • Where appropriate, consider using an annual wellness visit code instead (HCPCS G0438-G0439).

90461-90461, 90471-90472 
Must be coded with the vaccine(s) administered

 

Find-A-Code™ - Preventive Services - The information in this document does not guarantee payment or that included codes meet applicable qualifications as preventive services for all insurances and insurance plans, please consult your payer.

 

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Alcohol Misuse Screening and Counseling 

Procedure Codes 
G0442: Annual alcohol misuse screening, 15 minutes 
G0443: Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes 
99408: Alcohol and/or substance (other than tobacco) abuse structured screening (eg, AUDIT, DAST), and brief intervention (SBI) services; 15 to 30 minutes 
99409: Alcohol and/or substance (other than tobacco) abuse structured screening (eg, AUDIT, DAST), and brief intervention (SBI) services; greater than 30 minutes

ICD-10-CM 
No specific diagnosis code

Frequency 
G0442: Once annually 
G0443: 4 times per year for those who test positive 
99408-99409: No frequency guidelines specified

 

Additional Information 

99408-99409

  • Not covered by Medicare for preventative care, consider using G0442 or G0443 instead, as supported by documentation

G0442, G0443, 99409

  • If a patient is positive for alcohol misuse (but not alcohol dependence) documentation should include that they met two additional criteria:
    • They are competent and alert during counseling
    • Counseling is provided by a qualified provider in a primary care setting
  • Treatments for substance abuse/misuse is required to be covered per ACA guidelines

 

Find-A-Code™ - Preventive Services - The information in this document does not guarantee payment or that included codes meet applicable qualifications as preventive services for all insurances and insurance plans, please consult your payer.

 

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Screening for Anemia

Procedure Codes
85004: Blood count; automated differential WBC count
85014: Blood count; hematocrit (Hct)
85013: Blood count; spun microhematocrit
85018: Blood count; hemoglobin (Hgb)
80055: Obstetric panel

ICD-10-CM 
85004, 85013-85014, 85018: Z00.121, Z00.129, Z00.110, Z00.111, Z13.0
80055, 85004, 85014, 85013: O00.0-O03.9, O08.0-O08.9, O09.00-O09.93, O10.011-O16.9, O20.0-O29.93, O30.001-O48.1, O60.00-O77.9, O80&–O82, O98.011-O98.93, O99.111-O9A.53, Z33.1-Z33.2, Z34.00-Z34.93, Z36, Z03.71-Z03.79

 

Frequency 
85004, 85013-85014, 85018: No frequency limit 
80055: No frequency guidelines

Additional Information 

85004, 85013-85014, 85018

  • Can be covered from birth until the patients 21st birthday

80055, 85004, 85014, 85013

  • Can be covered for pregnant women

85004, 85013-85014, 85018, 80055

  • Not covered by Medicare for preventative care

 

Find-A-Code™ - Preventive Services - The information in this document does not guarantee payment or that included codes meet applicable qualifications as preventive services for all insurances and insurance plans, please consult your payer.

 

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Annual Wellness Visit 

Procedure Codes 
G0438: Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit 
G0439: Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit 
99385: Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 18-39 years 
99386: Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 40-64 years 
99387: Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 65 years and older 
59425: Antepartum care only; 4-6 visits 
59426: Antepartum care only; 7 or more visits

ICD-10-CM 
G0438, G0439: No specific diagnoses 
99385-99387, 59425-59426: Z00.00, Z00.01, Z01.411, Z01.419

 

Frequency 
G0439: Once annually 
G0438, 99385-99387: Once in a lifetime 
59425-59426: As appropriate

Additional Information 

59425-59426

  • Only appropriate for expecting women close to her due date
  • May not be covered as preventive by Medicare, consult your payer

99385-99387, 59425-59426

  • These are well-woman visits, only covered as preventive for female patients
  • HHS Requirement: Well-woman preventive care visit annually for adult women to obtain the recommended preventive services that are age and developmentally appropriate, including preconception and prenatal care

99385-99387

  • Not covered by Medicare for preventative care, consider using G0438 instead, or G0439 for subsequent visits

 

Find-A-Code™ - Preventive Services - The information in this document does not guarantee payment or that included codes meet applicable qualifications as preventive services for all insurances and insurance plans, please consult your payer.

 

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Bone Mass Measurements

Procedure Codes 
G0130: Single energy x-ray absorptiometry (sexa) bone density study, one or more sites; appendicular skeleton (peripheral) (eg, radius, wrist, heel) 
76977: Ultrasound bone density measurement and interpretation, peripheral site(s), any method 
77078: Computed tomography, bone mineral density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine) 
77079:Computed tomography, bone mineral density study, 1 or more sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel) 
77080: Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine) 
77081: Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; appendicular skeleton (peripheral) (eg, radius, wrist, heel)

ICD-10-CM 
G0130, 76977, 77078-77081: Z13.820, Z82.62

 

Frequency 
G0130, 76977, 77078-77081: Every two years or as often as documentably, medically necessary

Additional Information 
G0130, 76977, 77078-77081

  • Coverage may also be indicated in the following situations:
    • If a woman is determined to be estrogen deficient, and at clinical risk for osteoporosis, by a qualified provider
    • In those with vertebral abnormalities
    • In those receiving, or expecting to receive, glucocorticoid therapy for more than 3 months
    • In those with primary hyperparathyroidism
    • In participants of FDA approved osteoporosis drug therapy who are being monitored to assess their response to the treatment

 

Find-A-Code™ - Preventive Services - The information in this document does not guarantee payment or that included codes meet applicable qualifications as preventive services for all insurances and insurance plans, please consult your payer.

 

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Breast Cancer Genetic Screening

Procedure Codes 
81211: BRCA1, BRCA2 (breast cancer 1 and 2) (eg, hereditary breast and ovarian cancer) gene analysis; full sequence analysis and common duplication/deletion variants in BRCA1 (ie, exon 13 del 3.835kb, exon 13 dup 6kb, exon 14-20 del 26kb, exon 22 del 510bp, exon 8-9 del 7.1kb) 
81212: BRCA1, BRCA2 (breast cancer 1 and 2) (eg, hereditary breast and ovarian cancer) gene analysis; 185delAG, 5385insC, 6174delT variants 
81213: BRCA1, BRCA2 (breast cancer 1 and 2) (eg, hereditary breast and ovarian cancer) gene analysis; uncommon duplication/deletion variants 
81214: BRCA1 (breast cancer 1) (eg, hereditary breast and ovarian cancer) gene analysis; full sequence analysis and common duplication/deletion variants (ie, exon 13 del 3.835kb, exon 13 dup 6kb, exon 14-20 del 26kb, exon 22 del 510bp, exon 8-9 del 7.1kb) 
81215: BRCA1 (breast cancer 1) (eg, hereditary breast and ovarian cancer) gene analysis; known familial variant 
81216: BRCA2 (breast cancer 2) (eg, hereditary breast and ovarian cancer) gene analysis; full sequence analysis 
81217: BRCA2 (breast cancer 2) (eg, hereditary breast and ovarian cancer) gene analysis; known familial variant 
96040: Medical genetics and genetic counseling services, each 30 minutes face-to-face with patient/family

 

ICD-10-CM 
81211-81217, 96040: Z85.3; Z85.43; Z80.0; Z80.3; Z80.41, Z80.42

Frequency 
81211-81217, 96040: No specific frequency guidelines

Additional Information 

81211-81217, 96040

  • Not covered by Medicare for preventative care

 

Find-A-Code™ - Preventive Services - The information in this document does not guarantee payment or that included codes meet applicable qualifications as preventive services for all insurances and insurance plans, please consult your payer.

 

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Breastfeeding Supplies

Procedure Codes 
A4286: Locking ring for breast pump, replacement 
E0602: Breast pump, manual, any type 
E0603: Breast pump, electric (ac and/or dc), any type 
E0604: Breast pump, hospital grade, electric (ac and / or dc), any type 
S9443: Lactation classes, non-physician provider, per session

ICD-10-CM 
A4286, E0602-E0604, S9443: No specific diagnoses

 

Frequency 
A4286, E0602-E0604, S9443: No specific frequency guidelines

Additional Information 
A4286, E0602-E0604, S9443

  • Not covered by Medicare for preventative care
  • Only covered for women
  • Counseling for breastfeeding is covered as preventive, consider using a general E/M code, listed on the general procedures page of this document

 

Find-A-Code™ - Preventive Services - The information in this document does not guarantee payment or that included codes meet applicable qualifications as preventive services for all insurances and insurance plans, please consult your payer.

 

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Cardiovascular Disease Screening Tests

Procedure Codes 
80061: Lipid panel. This panel must include the following:

  • Cholesterol, serum, total
  • Lipoprotein, direct measurement, high density cholesterol (HDL cholesterol)
  • Triglycerides

82465: Cholesterol, serum, total 
83718: Lipoprotein, direct measurement, high density cholesterol (HDL cholesterol) 
84478: Triglycerides 
83721: Lipoprotein, direct measurement; LDL cholesterol 
83719: Lipoprotein, direct measurement; VLDL cholesterol

ICD-10-CM 
80061, 82465, 83718, 84478, 83721, 83719: Z13.220, Z13.6, Z82.49

 

Frequency 
80061, 82465, 83718, 84478: Once every 5 years 
83721, 83719: No specific frequency guidelines

Additional Information 

80061, 82465, 83718, 84478, 83721, 93719

  • May be covered by some payers as screening for cholesterol or lipid disorders
  • Patients do not necessarily need to show signs or symptoms of cardiovascular disease to have coverage, consult your payer

83721, 93719

  • Not covered by Medicare for preventative care

 

Find-A-Code™ - Preventive Services - The information in this document does not guarantee payment or that included codes meet applicable qualifications as preventive services for all insurances and insurance plans, please consult your payer.

 

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Cervical Dysplasia Screening

 

Procedure Codes
88141: Cytopathology, cervical or vaginal (any reporting system), requiring interpretation by physician 
88142: Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; manual screening under physician supervision
88143: Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; with manual screening and rescreening under physician supervision
88147: Cytopathology smears, cervical or vaginal; screening by automated system under physician supervision
88148: Cytopathology smears, cervical or vaginal; screening by automated system with manual rescreening under physician supervision
88150: Cytopathology, slides, cervical or vaginal; manual screening under physician supervision
88152: Cytopathology, slides, cervical or vaginal; with manual screening and computer-assisted rescreening under physician supervision
88153: Cytopathology, slides, cervical or vaginal; with manual screening and rescreening under physician supervision
88155: Cytopathology, slides, cervical or vaginal, definitive hormonal evaluation (eg, maturation index, karyopyknotic index, estrogenic index) (List separately in addition to code[s] for other technical and interpretation services)
88164: Cytopathology, slides, cervical or vaginal (the Bethesda System); manual screening under physician supervision

  88165: Cytopathology, slides, cervical or vaginal (the Bethesda System); with manual screening and rescreening under physician supervision
88166: Cytopathology, slides, cervical or vaginal (the Bethesda System); with manual screening and computer-assisted re-screening under physician supervision
88167: Cytopathology, slides, cervical or vaginal (the Bethesda System); with manual screening and computer-assisted rescreening using cell selection and review under physician supervision
88174: Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; screening by automated system, under physician supervision
88175: Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; with screening by automated system and manual rescreening or review, under physician supervision

ICD-10-CM
88141-88143, 88147-88148, 88150, 88152-88153, 88155, 88164-88167, 88174-88175: Z00.00, Z00.01, Z00.110, Z00.111, Z12.4, Z77.21, Z77.9

Additional Information
88141-88143, 88147-88148, 88150, 88152-88153, 88155, 88164-88167, 88174-88175

  • Not covered by Medicare for preventative care

 

Find-A-Code™ - Preventive Services - The information in this document does not guarantee payment or that included codes meet applicable qualifications as preventive services for all insurances and insurance plans, please consult your payer.

 

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Colorectal Cancer Screening

Procedure Codes 
G0104: Colorectal cancer screening; flexible sigmoidoscopy 
G0105: Colorectal cancer screening; colonoscopy on individual at high risk 
G0106: Colorectal cancer screening; screening sigmoidoscopy, barium enema 
G0121: Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk 
G0122: Colorectal cancer screening; barium enema 
G0328: Colorectal cancer screening; fecal occult blood test, immunoassay, 1-3 simultaneous 
G0500: Moderate sedation services provided by the same physician or other qualified health care professional performing a gastrointestinal endoscopic service that sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; initial 15 minutes of intra-service time; patient age 5 years or older (additional time may be reported with 99153, as appropriate) 
S0285: Colonoscopy consultation performed prior to a screening colonoscopy procedure 
00811:Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; not otherwise specified 
00812:Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; screening colonoscopy 
45346: Sigmoidoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed) 
45381: Colonoscopy, flexible; with directed submucosal injection(s), any substance 
45300: Proctosigmoidoscopy, rigid; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure) 
45305: Proctosigmoidoscopy, rigid; with biopsy, single or multiple 
45308: Proctosigmoidoscopy, rigid; with removal of single tumor, polyp, or other lesion by hot biopsy forceps or bipolar cautery 
45309: Proctosigmoidoscopy, rigid; with removal of single tumor, polyp, or other lesion by snare technique 
45315: Proctosigmoidoscopy, rigid; with removal of multiple tumors, polyps, or other lesions by hot biopsy forceps, bipolar cautery or snare technique 
45317: Proctosigmoidoscopy, rigid; with control of bleeding (eg, injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator) 
45330: Sigmoidoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) 
45331: Sigmoidoscopy, flexible; with biopsy, single or multiple 
45333: Sigmoidoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps 
45338: Sigmoidoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique 
45378: Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) 
45380: Colonoscopy, flexible; with biopsy, single or multiple 
45384: Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps 
45385: Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique 
45388: Colonoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed) 
81528: Oncology (colorectal) screening, quantitative real-time target and signal amplification of 10 DNA markers (KRAS mutations, promoter methylation of NDRG4 and BMP3) and fecal hemoglobin, utilizing stool, algorithm reported as a positive or negative result

 

  82270: Blood, occult, by peroxidase activity (eg, guaiac), qualitative; feces, consecutive collected specimens with single determination, for colorectal neoplasm screening (ie, patient was provided 3 cards or single triple card for consecutive collection)
82274: Blood, occult, by fecal hemoglobin determination by immunoassay, qualitative, feces, 1-3 simultaneous determinations 
99152: Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; initial 15 minutes of intraservice time, patient age 5 years or older 
99153: Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; each additional 15 minutes intraservice time (List separately in addition to code for primary service) 
99241: Office consultation for a new or established patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 15 minutes are spent face-to-face with the patient and/or family. 
99242: Office consultation for a new or established patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified healthcare professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low severity. Typically, 30 minutes are spent face-to-face with the patient and/or family. 
99243: Office consultation for a new or established patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Typically, 40 minutes are spent face-to-face with the patient and/or family. 
99244: Office consultation for a new or established patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 60 minutes are spent face-to-face with the patient and/or family. 
99245: Office consultation for a new or established patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 80 minutes are spent face-to-face with the patient and/or family.

Frequency 
G0104-G0106, G0121, G0328, 82270 
Normal Risk:

  • Cologuard™ Multitarget Stool DNA (sDNA) Test: once every 3 years;
  • Screening FOBT: every year;
  • Screening flexible sigmoidoscopy: once every 4 years (unless a screening colonoscopy has been performed and then Medicare may cover a screening flexible sigmoidoscopy only after at least 119 months);
  • Screening colonoscopy: every 10 years (unless a screening flexible sigmoidoscopy has been performed and then Medicare may cover a screening colonoscopy only after 47 months); and
  • Screening barium enema (as an alternative to covered screening flexible sigmoidoscopy)

High Risk:

  • Screening FOBT: every year;
  • Screening flexible sigmoidoscopy: once every 4 years;
  • Screeningcolonoscopy: every 2 years (unless a screeningflexiblesigmoidoscopy has been performed and then Medicare may cover ascreeningcolonoscopy only after at least 47 months); and
  • Screening barium enema (as an alternative to covered screening flexible sigmoidoscopy or colonoscopy)

All other codes in this section: Depends on the risk and other factors, consult your payer

ICD-10-CM
81528: Z00.00 Z00.01 Z01.411 Z01.419 Z12.10 Z12.11 Z12.12 Z12.13 R19.5
G0104-G0106, G0121-G0122, G0328, G0500, 82270, 82274, 45330-45333, 45338, 45346, 45378, 45380-45381, 45384-45385, 45388, 45300, 45305, 45308, 45309, 45315-45317, 99152-99153: Z83.71, Z83.79, Z12.12, Z12.10, Z12.11, R19.5
S0285, 99241-99245: Z12.11, Z83.81, Z83.79

 

Additional Information 
G0104-G0106, G0121, G0328, 82270

  • These are the only codes for colorectal cancer screening covered as preventive with Medicare
  • For those aged 50 and older, or anyone at high risk

G0104-G0106

  • When these services are provided initially, all surgical procedures provided on the same date and in the same encounter do not require a deductible, this can be indicated on the other surgical procedure code with modifier PT

G0106

  • Copayment and/or deductible may still apply. Consult your payer

81528

  • For beneficiaries aged 50-75

G0121

  • No age limitation, for individuals not meeting criteria for high risk

S0285, 99241-99245

  • Must be billed with modifier 33 to be considered preventive

00811, 00812, Modifier PT

  • Effective for claims with dates of service on or after January 1, 2018, Medicare will pay claim lines with new CPT code 00812 and waive the deductible and coinsurance. When a screening colonoscopy becomes a diagnostic colonoscopy, anesthesia services are reported with CPT code 00811 (Anesthesia for lower intestinal endoscopic procedures, endoscopy introduced distal to duodenum; not otherwise specified) and with the PT modifier.

 

Find-A-Code™ - Preventive Services - The information in this document does not guarantee payment or that included codes meet applicable qualifications as preventive services for all insurances and insurance plans, please consult your payer.

 

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Contraceptive Methods

Procedure Codes 
A4261: Cervical cap for contraceptive use 
A4266: Diaphragm for contraceptive use 
A4264: Permanent implantable align="center" contraceptive intratubal occlusion device(s) and delivery system 
J7300: Intrauterine copper contraceptive 
J7301: Levonorgestrel-releasing intrauterine contraceptive system (skyla), 13.5 mg 
J7303: Contraceptive supply, hormone containing vaginal ring, each 
J7304: Contraceptive supply, hormone containing patch, each 
J7306: Levonorgestrel (contraceptive) implant system, including implants and supplies 
J7307: Etonogestrel (contraceptive) implant system, including implant and supplies 
J7296: Levonorgestrel-releasing intrauterine contraceptive system, (kyleena), 19.5 mg 
J7297: Levonorgestrel-releasing intrauterine contraceptive system (liletta), 52 mg 
J7298: Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg 
J1050: Injection, medroxyprogesterone acetate, 1 mg 
00851: Anesthesia for intraperitoneal procedures in lower abdomen including laparoscopy; tubal ligation/transection 
11976: Removal, implantable align="center" contraceptive capsules 
11981: Insertion, non-biodegradable drug delivery implant 
11982: Removal, non-biodegradable drug delivery implant 
11983: Removal with reinsertion, non-biodegradable drug delivery implant

 

  57170: Diaphragm or cervical cap fitting with instructions 
58300: Insertion of intrauterine device (IUD 
58301: Removal of intrauterine device (IUD) 
58340: Catheterization and introduction of saline or contrast material for saline infusion sonohysterography (SIS) or hysterosalpingography 
58565: Hysteroscopy, surgical; with bilateral fallopian tube cannulation to induce occlusion by placement of permanent implants 
58600: Ligation or transection of fallopian tube(s), abdominal or vaginal approach, unilateral or bilateral 
58605: Ligation or transection of fallopian tube(s), abdominal or vaginal approach, postpartum, unilateral or bilateral, during same hospitalization (separate procedure) 
58611: Ligation or transection of fallopian tube(s) when done at the time of cesarean delivery or intra-abdominal surgery (not a separate procedure) (List separately in addition to code for primary procedure) 
58615: Occlusion of fallopian tube(s) by device (eg, band, clip, Falope ring) vaginal or suprapubic approach 
58670: Laparoscopy, surgical; with fulguration of oviducts (with or without transection) 
58671: Laparoscopy, surgical; with occlusion of oviducts by device (eg, band, clip, or Falope ring) 
74740: Hysterosalpingography, radiological supervision and interpretation 
76830: Ultrasound, transvaginal 
96372: Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular

ICD-10-CM 
A4261, A4266, J1050, J7300-J7301, J7303-J7304, J7306-J7307, J7296-J7298, 11981-11983, 11976, 57150, 58300-58301, 96372: T83.31XA-T83.39XS, T83.59XA – T83.6XXS, T83.81XA–T83.9XXS, Z30.011-Z30.9, Z98.51, Z97.5
58340, 74740: Z30.42, Z98.51
58565: Z30.2
76830: Z30.011 Z30.013 Z30.014 Z30.02 Z30.09 Z30.2 Z30.40 ;Z30.41 Z30.42 Z30.430 Z30.431 Z30.432 Z30.433 Z30.46 Z30.49& Z30.8 Z30.9 Z98.51
A4246, 58600, 58605, 58611, 58615, 58671, 58670, 00851: No specific diagnoses

Frequency 
A4261, A4266, J1050, J7301, J7303-J7304, J7306-J7307, J7296-J7298, 11981-11983, 11976, 57150, 58300-58301, 96372, 58340, 74740, A4246, 58600, 58605, 58611, 58615, 58671, 58670, ;00851, 76830: No specific frequency guidelines

 

Additional Information
A4261, A4266, J1050, J7301, J7303-J7304, J7306-J7307, J7296-J7298, 11981-11983, 11976, 57150, 58300-58301, 96372, 58340, 74740, A4246, 58600, 58605, 58611, 8615, 58671, 58670, 00851

  • Visits for side-effects should be coded with codes 99201-99215, as supported with the documentation, with modifier 33

Not covered by Medicare for preventative care, consult your payer for full guidelines

 

Find-A-Code™ - Preventive Services - The information in this document does not guarantee payment or that included codes meet applicable qualifications as preventive services for all insurances and insurance plans, please consult your payer.

 

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Counseling to Prevent Tobacco Use 

Procedure Codes 
99406: Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes 
99407: Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes

ICD-10-CM 
99406-99407: No specific diagnoses

Frequency 
99406-99407: 2 attempts a year, that may include up to 4 sessions each.

 

Additional Information 
99406-99407

  • These can be paid regardless of whether or not the beneficiary shows any signs or symptoms of tobacco related diseases or conditions
  • They must be competent and alert at the time of counseling
  • These procedure codes above replaced G0436 and G0437, (do not report these G-codes).

 

Find-A-Code™ - Preventive Services - The information in this document does not guarantee payment or that included codes meet applicable qualifications as preventive services for all insurances and insurance plans, please consult your payer.

 

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Dental Caries in Children

Procedure Codes 
99188: Application of topical fluoride varnish by a physician or other qualified health care professional

ICD-10-CM 
99188: No specific diagnoses

 

Frequency 
99188: No specific frequency guidelines

Additional Information 
99188

  • Covered for children from birth until their seventh birthday

 

Find-A-Code™ - Preventive Services - The information in this document does not guarantee payment or that included codes meet applicable qualifications as preventive services for all insurances and insurance plans, please consult your payer.

 

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Depression Screening 

Procedure Codes 
G0444: Annual depression screening, 15 minutes 
96127: Brief emotional/behavioral assessment (eg, depression inventory, attention-deficit/hyperactivity disorder [ADHD] scale), with scoring and documentation, per standardized instrument

ICD-10-CM 
G0444, 96127: No specific diagnoses

Frequency 
G0444:Once annually 
96127: No specific frequency guidelines

 

Additional Information 
96127

  • Only covered for ages prenatal to 21 (ends on their 21st birthday)
  • Not covered by Medicare for preventative care

G0444

  • Must be provided in a primary care setting with staff-assisted care supports to ensure accurate diagnosis, treatment, and follow-up
  • Supporting diagnosis codes vary, contact your payer for specific guidance

 

Find-A-Code™ - Preventive Services - The information in this document does not guarantee payment or that included codes meet applicable qualifications as preventive services for all insurances and insurance plans, please consult your payer.

 

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Diabetes Screening

Procedure Codes 
82947: Glucose; quantitative, blood (except reagent strip) 
82948: Glucose; blood, reagent strip 
82950: Glucose; post glucose dose (includes glucose) 
82951: Glucose; tolerance test (GTT), 3 specimens (includes glucose) 
82952: Glucose; tolerance test, each additional beyond 3 specimens (List separately in addition to code for primary procedure) 
83036: Hemoglobin; glycosylated (A1C)

ICD-10-CM 
82947-82952, 83036: Z13.1, O00.0-O03.9, O08.0-O08.9, O09.00-O09.93, O10.011-O16.9, O20.0-O29.93, O30.001-O48.1, O80-O82, O98.011-O98.93, O99.111-O9A.53, Z33.1-Z33.2, Z34.00-Z03.79

Frequency 
82947, 82950-82951: 2 per year if diagnosed with prediabetes or once per year if previously tested but not diagnosed with prediabetes or if never tested
82948, 82952, 83036: No frequency guidelines specified

 

Additional Information 

82947, 82950-82951

  • Medicare will cover as preventive for beneficiaries with certain risk factors or pre-diabetes
  • Those previously diagnosed with diabetes are not eligible for this benefit

82948, 82952, 83036

  • Not covered by Medicare for preventative care

82952

  • Add-on code, do not code alone

 

Find-A-Code™ - Preventive Services - The information in this document does not guarantee payment or that included codes meet applicable qualifications as preventive services for all insurances and insurance plans, please consult your payer.

 

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Diabetes Self-Management Training 

Procedure Codes 
G0108: DSMT, individual, per 30 minutes 
G0109: GDSMT, group (2 or more), per 30 minutes

ICD-10-CM 
G0108-G0109: Contact payer for more specific guidelines

Frequency 
G0108-G0109

  • Initial year: Up to 10 hours of initial training within a continuous 12-month period
  • Subsequent years: Up to 2 hours of follow-up training each year after the initial year
 

Additional Information 
G0108-G0109

  • Beneficiaries must receive an order for the training by their physician or qualified non-physician practitioner treating the diabetes to qualify it as preventive

 

Find-A-Code™ - Preventive Services - The information in this document does not guarantee payment or that included codes meet applicable qualifications as preventive services for all insurances and insurance plans, please consult your payer.

 

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Therapy for Fall Prevention

Procedure Codes 
97110: Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility 
97112: Therapeutic procedure, 1 or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities 
97116: Therapeutic procedure, 1 or more areas, each 15 minutes; gait training (includes stair climbing) 
97530: Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes

ICD-10-CM 
97110, 97112, 97116, 97530: Z91.81 should be the primary diagnosis, no specified secondary diagnoses

 

Frequency 
97110, 97112, 97116, 97530: No specific frequency guidelines

Additional Information 
97110, 97112, 97116, 97530

  • Not covered as preventive by all payers or payer plans
  • Limited to ages 65 and older who have higher risk of falls
  • May be subject to cost shares and limits

 

Find-A-Code™ - Preventive Services - The information in this document does not guarantee payment or that included codes meet applicable qualifications as preventive services for all insurances and insurance plans, please consult your payer.

 

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Glaucoma Screening

Procedure Codes 
G0117: Glaucoma screening for high risk patients furnished by an optometrist or ophthalmologist 
G0118: Glaucoma screening for high risk patient furnished under the direct supervision of an optometrist or ophthalmologist

ICD-10-CM 
G0117-G0118: Z13.5

Frequency 
G0117-G0118: Once a year

 

Additional information 
G0117-G0118

  • Coverage as is indicated with certain high risk factors:
    • Diabetes mellitus
    • Family history of glaucoma
    • African-Americans aged 50 and older
    • Hispanic-Americans aged 65 and older
  • For Medicare beneficiaries deductible and copayment may still apply

 

Find-A-Code™ - Preventive Services - The information in this document does not guarantee payment or that included codes meet applicable qualifications as preventive services for all insurances and insurance plans, please consult your payer.

 

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Hepatitis B Virus (HBV) Vaccine and Administration

Procedure Codes 
G0010: Administration of hepatitis b vaccine 
90739: Hepatitis B vaccine (HepB), adult dosage, 2 dose schedule, for intramuscular use 
90740: Hepatitis B vaccine (HepB), dialysis or immunosuppressed patient dosage, 3 dose schedule, for intramuscular use 
90743: Hepatitis B vaccine (HepB), adolescent, 2 dose schedule, for intramuscular use 
90744: Hepatitis B vaccine (HepB), pediatric/adolescent dosage, 3 dose schedule, for intramuscular use 
90746: Hepatitis B vaccine (HepB), adult dosage, 3 dose schedule, for intramuscular use 
90747: Hepatitis B vaccine (HepB), dialysis or immunosuppressed patient dosage, 4 dose schedule, for intramuscular use 
86704: Hepatitis B core antibody (HBcAb); total 
86706: Hepatitis B surface antibody (HBsAb) 
87340: Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; hepatitis B surface antigen (HBsAg) 
87341: Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; hepatitis B surface antigen (HBsAg) neutralization 
90636: Hepatitis A and hepatitis B vaccine (HepA-HepB), adult dosage, for intramuscular use

 

ICD-10-CM
G0010, 90636, 90739-90740, 90743-90744, 90746-90747: Z23
86704, 86706, 87340, 87341: O00.0-O03.9, O08.0-O08.9, O09.00-O09.93, O10.011-O16.9, O20.0-O29.93, O30.001-O48.1, O80-O82, O98.011-O98.93, O99.111-O9A.53, Z33.1-Z33.2, Z34.00-Z03.79

Frequency 
G0010, 90739-90740, 90743-90744, 90746-90747, 86704, 86706, ;87340, 87341, 90636: As often as appropriate, scheduled doses required

Additional Information
G0010, 90739-90740, 90743-90744, 90746-90747, 86704, 86706, 87340, 87341

  • Those currently positive for hep B antibodies aren’t eligible

86704, 86706, 87340, 87341

  • Not covered by Medicare for preventative care
  • Meant for screening in pregnancy

 

Find-A-Code™ - Preventive Services - The information in this document does not guarantee payment or that included codes meet applicable qualifications as preventive services for all insurances and insurance plans, please consult your payer.

 

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Hepatitis C Virus (HCV) Screening

Procedure Codes 
G0472: Hepatitis c antibody screening, for individual at high risk and other covered indication(s) 
87522: Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, quantification, includes reverse transcription when performed 
86804: Hepatitis C antibody; confirmatory test (eg, immunoblot) 
86803: Hepatitis C antibody;

ICD-10-CM 
G0472: Z72.89, F19.20 
87522, 86804, 86803: Any diagnosis except those for hepatitis C

 

Frequency 
G0472: Annually for high risk individuals with continued illicit intravenous drug use, once in a lifetime for those born 1945-1965 and aren’t considered high risk 
87522, 86804, 86803: No specified frequency guidelines

Additional Information 
87522, 86804, 86803:

  • Not covered by Medicare for preventative care

 

Find-A-Code™ - Preventive Services - The information in this document does not guarantee payment or that included codes meet applicable qualifications as preventive services for all insurances and insurance plans, please consult your payer.

 

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Human Immunodeficiency Virus (HIV) Screening

Procedure Codes 
G0432: Infectious agent antibody detection by enzyme immunoassay (eia) technique, hiv-1 and/or hiv-2, screening 
G0433: Infectious agent antibody detection by enzyme-linked immunosorbent assay (elisa) technique, hiv-1 and/or hiv-2, screening 
G0435: Infectious agent antibody detection by rapid antibody test, hiv-1 and/or hiv-2, screening 
86701: Antibody; HIV-1 
86702: Antibody; HIV-2 
86703: Antibody; HIV-1 and HIV-2, single result 
86689: Antibody; HTLV or HIV antibody, confirmatory test (eg, Western Blot) 
87389: Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; HIV-1 antigen(s), with HIV-1 and HIV-2 antibodies, single result 
87390: Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; HIV-1 antigen(s), with HIV-1 and HIV-2 antibodies, single result 
87391: Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; HIV-2

 

ICD-10-CM 
G0432-G0435: Z11.59 for the primary diagnosis, Z72.89, Z34.00, Z34.80, Z34.90, O09.90-O09.93 as secondary diagnosis as appropriate 
86701-86703, 86689, 87389-87391: All diagnoses except those for HIV

Frequency 
G0432-G0435: Annually for beneficiaries at increased risk, including anyone who asks for the test For beneficiaries who are pregnant, 3 times per pregnancy. First, when a woman is diagnosed with pregnancy; Second, during the third trimester; Third, at labor, if ordered by the woman’s clinician 
86701-86703, 86689, 87389-87391: No specified frequency guidelines

Additional Information 
86701-86703, 86689, 8738-87391

  • Not covered by Medicare for preventative care

 

Find-A-Code™ - Preventive Services - The information in this document does not guarantee payment or that included codes meet applicable qualifications as preventive services for all insurances and insurance plans, please consult your payer.

 

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Human Papilomavirus (HPV) Vaccine and Screening

Procedure Codes 
87623: Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), low-risk types (eg, 6, 11, 42, 43, 44) 
87624: Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), high-risk types (eg, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68) 
87625: Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), types 16 and 18 only, includes type 45, if performed 
90649: Human Papillomavirus vaccine, types 6, 11, 16, 18, quadrivalent (4vHPV), 3 dose schedule, for intramuscular use 
90650: Human Papillomavirus vaccine, types 16, 18, bivalent (2vHPV), 3 dose schedule, for intramuscular use 
90651: Human Papillomavirus vaccine types 6, 11, 16, 18, 31, 33, 45, 52, 58, nonavalent (9vHPV), 2 or 3 dose schedule, for intramuscular use

ICD-10-CM 
87623-87625: Z00.00, Z00.01, Z01.411, Z01.419, Z11.51, Z12.4 
90649-90651: Z23

 

Frequency 
87623-87625: Every 3 years for women who are 30 or older who have normal pap smear 
90649-90651: As scheduled

Additional Information 

87623-87625

  • May require modifier 33

90649-90651

  • May not covered by Medicare
  • Requires a code for the administration as well (See general codes to find the appropriate one)

 

Find-A-Code™ - Preventive Services - The information in this document does not guarantee payment or that included codes meet applicable qualifications as preventive services for all insurances and insurance plans, please consult your payer.

 

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Initial Preventive Physical Examination (Medicare Only)

Procedure Codes 
G0402: Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment 
G0403: Electrocardiogram, routine ecg with 12 leads; performed as a screening for the initial preventive physical examination with interpretation and report 
G0404: Electrocardiogram, routine ecg with 12 leads; tracing only, without interpretation and report, performed as a screening for the initial preventive physical examination 
G0405: Electrocardiogram, routine ecg with 12 leads; interpretation and report only, performed as a screening for the initial preventive physical examination

ICD-10-CM 
G0402-G0405: No specific diagnoses

 

Frequency 
G0402-G0405: Once in a lifetime

Additional Information
G0403-G0405

  • Copayment and deductible still apply

G0402-G0405

  • Only covered in the first 12 months of the patients first Part B coverage period
  • Coverage varies by MAC, contact your payer

 

Find-A-Code™ - Preventive Services - The information in this document does not guarantee payment or that included codes meet applicable qualifications as preventive services for all insurances and insurance plans, please consult your payer.

 

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Medical Nutrition Therapy and

Cardiovascular Disease (CVD)/Obesity Prevention

Procedure Codes 
G0270: Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face to face with the patient, each 15 minutes 
G0271: Medical nutrition therapy, reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition, or treatment regimen (including additional hours needed for renal disease), group (2 or more individuals), each 30 minutes 
G0446: Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes

 

  G0447: Face-to-face behavioral counseling for obesity, 15 minutes 
G0473: Face-to-face behavioral counseling for obesity, group (2–10), 30 minutes 
97802: Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes 
97803: Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes 
97804: Medical nutrition therapy; group (2 or more individual(s)), each 30 minutes

ICD-10-CM 
G0446, G0270-G0271, 97802-97804: No specific diagnoses, contact prayer for guidance. 
G0447, G0473: Z68.30-Z68.39, Z68.41-Z68.45

Frequency 
G0446: Once annually for CVD risk reduction 
G0270-G0271, 97802-97804: 3 hours total in the first year, 2 hours total for subsequent years 
G0447, G0473: In the first year:

  • Once a week for the first month
  • Once every other week months 2-6
  • Once every month (where qualified) months 7-12
    • At the 6-month visit, a reassessment of obesity and a determination of the amount of weight loss must be performed.
    • To be eligible for additional face-to-face visits occurring once a month for an additional 6 months, beneficiaries must have lost at least 3kg.
    • For beneficiaries who do not achieve a weight loss of at least 3 kg during the first 6 months, a reassessment of their readiness to change and BMI is appropriate after an additional 6-month period.
 

Additional Information 
G0270-G0271, 97802-97804

  • With Medicare, the following three criteria have to be met:
    • Must receive a referral from their treating physician; and
    • Diagnosed with diabetes, renal disease, or have received a kidney transplant in the last 3 years; and
    • Services are provided by a registered dietitian or nutrition professional
  • Coverage criteria can vary, check with your payer

97802-97804

  • Requires the use of modifier 33 when USPSTF requirements are met

G0446-G0447, G0473

  • Beneficiary must be competent and alert at the time counseling is provided; and be performed by qualified primary provider in a primary care setting.

G0447, G0473

  • Only covered for obesity

 

Find-A-Code™ - Preventive Services - The information in this document does not guarantee payment or that included codes meet applicable qualifications as preventive services for all insurances and insurance plans, please consult your payer.

 

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Lung Cancer Screening

Procedure Codes 
G0296: Counseling visit to discuss need for lung cancer screening (ldct) using low dose ct scan (service is for eligibility determination and shared decision making) 
G0297: Low dose ct scan (ldct) for lung cancer screening 
S8092: Electron beam computed tomography (also known as ultrafast ct, cine ct) 
71250: Computed tomography, thorax; without contrast material

ICD-10-CM 
G0296-G0297, S8092, 71250: Z87.891, Z12.2

 

Frequency 
G0296-G0297, S8092, 71250: Once annually

Additional Information 
G0296-G0297, S8092, 71250

  • Covered as preventive for those ages 55-80
  • Additional screenings past one annually will be subject to cost sharing
  • Lung cancer screening coverage varies widely, consult your payer

 

Find-A-Code™ - Preventive Services - The information in this document does not guarantee payment or that included codes meet applicable qualifications as preventive services for all insurances and insurance plans, please consult your payer.

 

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Newborn Screenings/Tests

Procedure Codes 
82775: Galactose-1-phosphate uridyl transferase; quantitative 
83498: Hydroxyprogesterone, 17-d 
82017: Acylcarnitines; quantitative, each specimen 
82136: Amino acids, 2 to 5 amino acids, quantitative, each specimen 
82261: Biotinidase, each specimen 
83020: Hemoglobin fractionation and quantitation; electrophoresis (eg, A2, S, C, and/or F) 
83021: Hemoglobin fractionation and quantitation; chromatography (eg, A2, S, C, and/or F) 
83516: Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; qualitative or semiquantitative, multiple step method 
83789: Mass spectrometry and tandem mass spectrometry (eg, MS, MS/ MS, MALDI, MS-TOF, QTOF), non-drug analyte(s) not elsewhere specified, qualitative or quantitative, each specimen

 

  84030: Phenylalanine (PKU), blood 
84437: Thyroxine; requiring elution (eg, neonatal) 
84443: Thyroid stimulating hormone (TSH) 
85660: Sickling of RBC, reduction 
92558: Evoked otoacoustic emissions, screening (qualitative measurement of distortion product or transient evoked otoacoustic emissions), automated analysis 
92587: Distortion product evoked otoacoustic emissions; limited evaluation (to confirm the presence or absence of hearing disorder, 3-6 frequencies) or transient evoked otoacoustic emissions, with interpretation and report 
S3620: Newborn metabolic screening panel, includes test kit, postage and the laboratory tests specified by the state for inclusion in this panel (e.g. galactose; hemoglobin, electrophoresis; hydroxyprogesterone, 17-d; phenylanine (pku); and thyroxine, total)

ICD-10-CM 
92587, 92558: Z76.2, Z00.121, Z00.129, Z00.110, Z00.111, Z01.10, Z01.110
83020, 84443, 84437, 82018, 82136, 82261, 82775, 83498, 83516: Z13.29, Z13.228, Z13.21, Z13.0
84030, S3620: Z00.121, Z00.129, Z13.228, Z00.110, Z00.111, Z13.29, Z13.21, Z13.0
83789: Z00.121, Z00.129, Z13.228, ;Z00.110, Z00.111
85660, 83021: Z13.0

 

Frequency 
S3620, 92587, 92558, 82017, 82136, 82261, 82775, 83020-83021, 83498, 83516, 84030, 84437, 84443, 83789, 85660: No specific frequency guidelines

Additional Information 
S3620, 92587, 92558, 82017, 82136, 82261, 82775, 83020-83021, 83498, 83516, 84030, 84437, 84443, 83789, 85660

  • Only for newborns
  • Not covered by Medicare for preventative care

 

Find-A-Code™ - Preventive Services - The information in this document does not guarantee payment or that included codes meet applicable qualifications as preventive services for all insurances and insurance plans, please consult your payer.

 

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Pneumococcal Vaccine and Administration

Procedure Codes 
G0009: Administration of pneumococcal vaccine 
90670: Pneumococcal conjugate vaccine, 13 valent (PCV13), for intramuscular use 
90732: Pneumococcal polysaccharide vaccine, 23-valent (PPSV23), adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use

ICD-10-CM 
G0009, 90670, 90732: Z23

 

Frequency 
G0009, 90670, 90732: Twice, one year apart from each other

Additional Information 
G0009, 90670, 90732

  • Medicare beneficiaries covered only if not received already under part B.

 

Find-A-Code™ - Preventive Services - The information in this document does not guarantee payment or that included codes meet applicable qualifications as preventive services for all insurances and insurance plans, please consult your payer.

 

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Prostate Cancer Screening

Procedure Codes 
G0102: Prostate cancer screening; digital rectal examination 
G0103: Prostate cancer screening; prostate specific antigen test (PSA)

ICD-10-CM 
G0102-G0103: Z12.5

Frequency 
G0102-G0103: Once annually

 

Additional Information 
G0102-G0103

  • Only for males aged 50 and older

G0102

  • Copayment and deductible may apply, consult your payer

 

Find-A-Code™ - Preventive Services - The information in this document does not guarantee payment or that included codes meet applicable qualifications as preventive services for all insurances and insurance plans, please consult your payer.

 

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Screening for STIs and High Intensity

Behavioral Counseling (HIBC) to Prevent STIs

Procedure Codes 
86592: Syphilis test, non-treponemal antibody; qualitative (eg, VDRL, RPR, ART) 
86593: Syphilis test, non-treponemal antibody; quantitative 
86631: Antibody; Chlamydia 
86632: Antibody; Chlamydia, IgM 
86780: Antibody; Treponema pallidum 
87110: Culture, chlamydia, any source 
87270: Infectious agent antigen detection by immunofluorescent technique; Chlamydia trachomatis 
87320: Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Chlamydia trachomatis 
87340: Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; hepatitis B surface antigen (HBsAg) 
87341: Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; hepatitis B surface antigen (HBsAg) neutralization 
87490: Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, direct probe technique 
87491: Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, amplified probe technique

 

  87492: Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, quantification 
87590: Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae, direct probe technique 
87591: Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae, amplified probe technique 
87800: Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms; direct probe(s) technique 
87801: Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms; amplified probe(s) technique 
87810: Infectious agent antigen detection by immunoassay with direct optical observation; Chlamydia trachomatis 
87850: Infectious agent antigen detection by immunoassay with direct optical observation; Neisseria gonorrhoeae 
96150: Health and behavior assessment (eg, health-focused clinical interview, behavioral observations, psychophysiological monitoring, health-oriented questionnaires), each 15 minutes face-to-face with the patient; initial assessment 
96152: Health and behavior intervention, each 15 minutes, face-to-face; individual 
96153: Health and behavior intervention, each 15 minutes, face-to-face; group (2 or more patients) 
G0445: Semiannual high intensity behavioral counseling to prevent STIs, individual, face-to-face, includes education skills training & guidance on how to change sexual behavior, 30 minutes

Additional Information 
G0445, 96150-96153, 86631-86632, 87110, 87270, 87320, 87490-87491, 87810, 87590-87591, 87850, 87800, 86592-96593, 86780, 87340-87341

  • Coverage is indicated for beneficiaries that meet the following criteria:
    • Secually active adolescents and adults at increased risk for STIs
    • Referred by a primary care provider
    • Services provided by an eligible primary care provider in a primary care center
 

ICD-10-CM 
G0445: No specific diagnoses 
96150-96153, 86631-86632, 87110, 87270, 87320, 87490-87491, 87810, 87590-87591, 87850, 87800, 86592-96593, 86780, 87340-87341: Varies widely, consult your payer

Frequency 
G0445: Twice annually
96150-96153, 86631-86632, 87110, 87270, 87320, 87490-87491, 87810, 87590-87591, 87850, 87800, 86592-96593 86780, 87340-87341: Varies widely, consult your payer

 

Find-A-Code™ - Preventive Services - The information in this document does not guarantee payment or that included codes meet applicable qualifications as preventive services for all insurances and insurance plans, please consult your payer.

 

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Screening Mammography

Procedure Codes 
77052: Computer-aided detection (computer algorithm analysis of digital image data for lesion detection) with further physician review for interpretation, with or without digitization of film radiographic images; screening mammography (list separately in addition to code for primary procedure) 
77057: Screening mammography, bilateral (2-view film study of each breast) 
77067: Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed 
77063: Screening digital breast tomosynthesis, bilateral (List separately in addition to code for primary procedure)

ICD-10-CM 
77067, 77063: Z12.31

 

 

Frequency 
77067, 77063: Aged 35 through 39: One baseline. Aged 40 and older: Annually

Additional Information 
77067, 77063

  • If billing a screening mammogram and a diagnostic mammogram on the same day, use modifier –GG to show a screening mammogram turned into a diagnostic mammogram.

77063

  • Add on code
  • May not be covered as preventive

 

Find-A-Code™ - Preventive Services - The information in this document does not guarantee payment or that included codes meet applicable qualifications as preventive services for all insurances and insurance plans, please consult your payer.

 

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Screening Pap Tests

Procedure Codes 
G0123: Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision 
G0124: Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, requiring interpretation by physician 
G0141: Screening cytopathology smears, cervical or vaginal, performed by automated system, with manual rescreening, requiring interpretation by physician 
G0143: Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with manual screening and rescreening by cytotechnologist under physician supervision 
G0144: Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system, under physician supervision 
G0145: Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system and manual rescreening under physician supervision 
G0147: Screening cytopathology smears, cervical or vaginal, performed by automated system under physician supervision 
G0148: Screening cytopathology smears, cervical or vaginal, performed by automated system with manual rescreening 
P3000: Screening Pap smear by technician under physician supervision 
P3001: Screening Pap smear requiring interpretation by physician 
Q0091: Screening Pap smear; obtaining, preparing and conveyance to lab 
88141: Cytopathology, cervical or vaginal (any reporting system), requiring interpretation by physician 
88142: Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; manual screening under physician supervision

 

88143: Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; with manual screening and rescreening under physician supervision 
88147: Cytopathology smears, cervical or vaginal; screening by automated system under physician supervision 
88148: Cytopathology smears, cervical or vaginal; screening by automated system with manual rescreening under physician supervision 
88150: Cytopathology, slides, cervical or vaginal; manual screening under physician supervision 
88152: Cytopathology, slides, cervical or vaginal; with manual screening and computer-assisted rescreening under physician supervision 
88153: Cytopathology, slides, cervical or vaginal; with manual screening and rescreening under physician supervision 
88155: Cytopathology, slides, cervical or vaginal, definitive hormonal evaluation (eg, maturation index, karyopyknotic index, estrogenic index) (List separately in addition to code[s] for other technical and interpretation services) 
88164: Cytopathology, slides, cervical or vaginal (the Bethesda System); manual screening under physician supervision 
88165: Cytopathology, slides, cervical or vaginal (the Bethesda System); with manual screening and rescreening under physician supervision 
88166: Cytopathology, slides, cervical or vaginal (the Bethesda System); with manual screening and computer-assisted rescreening under physician supervision 
88167: Cytopathology, slides, cervical or vaginal (the Bethesda System); with manual screening and computer-assisted rescreening under physician supervision 
88174: Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; screening by automated system, under physician supervision 
88175: Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; with screening by automated system and manual rescreening or review, under physician supervision

 

ICD-10-CM 
G0123-G0124, G0141, G0143-G0145, G0147-G0148, P3000-P3001, Q0091: Low risk patients - Z01.411, Z01.419 Z12.4, Z12.72, Z12.89. High risk patients - Z77.9, Z92.84 Z92.89
88141-88143, 88147-88148, 88150, 88152-88153, 88155, 8164-88167, 8174, 88175: Z00.00, Z00.01, Z01.411, Z01.419, Z01.42, Z12.4, Z77.21, Z77.9

 

Frequency 
G0123-G0124, G0141, G0143-G0145, G0147-G0148, P3000-P3001, Q0091: Once annually for high risk patients, once every other year for normal risk patients
88141-88143, 88147-88148, 88150, 88152-88153, 88155, 88164-88167, 88174, 88175: No specified frequency guidelines

Additional Information 
88141-88143, 88147-88148, 88150, 88152-88153, 88155, 88164-88167, 88174, 88175

  • Not covered by Medicare for preventative care

 

Find-A-Code™ - Preventive Services - The information in this document does not guarantee payment or that included codes meet applicable qualifications as preventive services for all insurances and insurance plans, please consult your payer.

 

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Screening Gynecological Examination

Procedure Codes 
G0101: Cervical or vaginal cancer screening; pelvic and clinical breast examination 
S0610: Annual gynecological examination; clinical breast examination without pelvic evaluation 
S0612: Annual gynecological examination, established patient 
S0613: Annual gynecological examination, new patient

ICD-10-CM 
G0101:Low risk patients - Z01.411, Z01.419, Z12.4, Z12.72, Z12.89; High risk patients - Z77.9, Z92.84, Z92.89; 
S0610-S0613: Z01.411, Z01.419, Z00.00, Z00.01

 

Frequency 
G0101: Low risk patients - Once every other year; High risk patients - Once annually; 
S0610-S0613: Once annually

Additional Information 
G0101

  • For women only
  • Includes a breast exam

S0610-S0613

  • Some payers may not pay these codes as they are thought to be included in the usual annual well woman visit. Consult your payer before using

 

Find-A-Code™ - Preventive Services - The information in this document does not guarantee payment or that included codes meet applicable qualifications as preventive services for all insurances and insurance plans, please consult your payer.

 

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Ultrasound Screening for Abdominal Aortic Aneurysm (AAA)

Procedure Codes 
76706: Ultrasound, abdominal aorta, real time with image documentation, screening study for abdominal aortic aneurysm (AAA)
76770: Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real time with image documentation; complete
76775: Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real time with image documentation; limited

ICD-10-CM
76770, 76775: F17.200-F17.291, Z13.6, Z82.41, Z82.49, Z87.891

Frequency
76770, 76775: Once in a lifetime

 

Additional Notes
76770, 76775

  • Coverage provided for men aged 65 or older
  • For Medicare, diagnosis code doesn’t matter
  • May also be covered with certain risk factors
  • Contact your payer for more information

76706

  • The only code to use with Medicare after 1-1-2017

 

Find-A-Code™ - Preventive Services - The information in this document does not guarantee payment or that included codes meet applicable qualifications as preventive services for all insurances and insurance plans, please consult your payer.

 

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Screening Children for Visual Acuity

Procedure Codes 
99173: Screening test of visual acuity, quantitative, bilateral

ICD-10-CM 
99173: Z00.121, Z00.129, Z00.100, Z00.101

Frequency 
99173: No specific frequency guidelines

 

Additional Information 
99173

  • Not covered by Medicare for preventative care
  • Some policies will only cover as preventive for children, consult your payer

 

Find-A-Code™ - Preventive Services - The information in this document does not guarantee payment or that included codes meet applicable qualifications as preventive services for all insurances and insurance plans, please consult your payer.

 

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The Use of Modifier 33

Modifier 33 is used to indicate Preventive Services to report quality metrics and is informational only, it has no impact on reimbursement. Modifier 33 should be reported only to private payers, Medicare and Medicaid do not recognize this modifier.

Modifier 33 is used when the primary purpose of the service is the delivery of an evidence-based service in accordance with a USPSTF A or B rating in effect and other preventive services identified in preventive services mandates (legislative or regulatory), the service may be identified by adding 33 to the procedure. For separately reported services specifically identified as preventive, the modifier should not be used.

Preventative visit turned Diagnostic

You can apply modifier 33 if a screening turned diagnostic. according to CPT® Assistant, “is screening colonoscopy [45378 Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen(s) by brushing or washing, with or without colon decompression (separate procedure)] that results in a polypectomy [e.g., 45383 Colonoscopy, flexible, proximal to splenic flexure; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique].”

 

Find-A-Code™ - Preventive Services - The information in this document does not guarantee payment or that included codes meet applicable qualifications as preventive services for all insurances and insurance plans, please consult your payer.

 

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References

Kaiser Permanente
https://provider.ghc.org/open/coverageAndEligibility/groupHealthPlans/preventive-services-guidelines.pdf

Medicare Learning Network
https://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/Downloads/MPS-QuickReferenceChart-1TextOnlywithICD9.pdf

AAFP - ICD-10 Simplifies Preventive Care Coding, Sort Of - Cindy Hughes
https://www.aafp.org/fpm/2014/0700/oa1.html

List of ACA Preventive Services and CPT Codes - STDs
http://stdtac.org/wp-content/uploads/2014/06/List-of-ACA-Preventative-Services-and-CPT-Codes-_STDTAC.pdf

 

Find-A-Code™ - Preventive Services - The information in this document does not guarantee payment or that included codes meet applicable qualifications as preventive services for all insurances and insurance plans, please consult your payer.

 

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Additional Links and Resources

ACA guidelines as per healthcare.gov
https://www.healthcare.gov/coverage/preventive-care-benefits/

Preventive Medicine List
https://www1.ghc.org/static/pdf/public/formulary/aca-list.pdf

AAPC - Recommended Ways to Document and Report a Preventive Visit
https://www.aapc.com/blog/39873-recommended-ways-to-document-and-report-a-preventive-visit/

Published Recommendations according to Population/Grade per U.S. Preventive Services Task Force
https://www.uspreventiveservicestaskforce.org/BrowseRec/Index

Find-A-Code™ - Preventive Services - The information in this document does not guarantee payment or that included codes meet applicable qualifications as preventive services for all insurances and insurance plans, please consult your payer.

 

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Author: 
Find-A-Code™