Service Procedure Codes
Office Visit Hospital Visit 99381-99384, 99461, 99391-99394 99460, 99463
Developmental Test 96110, 96111
Immunizations 90460-90474, 90633-90634, 90645-90649, 90655-90658, 90660, 90664, 90666-90669, 90680, 90696, 90698, 90700-90708, 90710, 90712-90713, 90714-90715, 90716, 90718-90721, 90723, 90732, 90733, 90734, 90740, 90743-90744, 90747-90748, G0008-G0010, J1670, S0195
Preventive Medicine 99420, 99429
Preventive Counseling 99401-99404 99411-99412
TB 86580
UA 81000-81003
HCT 85004, 85007-85009, 85014, 85018, 85025
HBG 85027, 85032, 85041
UC 870861
Sickle – HB 83020
Sickle – SLD 85660
Lead 83655
PKU (In first month) 84030
Cholesterol 82465
Screening Ear 92551-92553 92585-92588 (infant)
Eye 92002, 92004, 92012, 92014, 99172, 99173
How do I bill for well-child preventive visits?
Step 1: Confirm that your services qualify as a preventive visit
By definition, a preventive visit is an initial or periodic comprehensive preventive medicine evaluation and management
(E/M), including:
** Age and gender appropriate history
** Examination
** Counseling/anticipatory guidance/risk factor reduction interventions
**Ordering of any necessary laboratory/diagnostic procedures
Step 2: Determine if your patient is a new or established patient Will my patient have any out-of-pocket cost*
Generally, no. All the above E/M codes, when accompanied by an appropriate diagnostic routine child health check code (Z00.xxx) are covered at 100 percent for patients with plan benefits that provide full coverage for preventive care.
However, if you bill an additional office visit code (for example, 15 minute expanded problem visit code 99213 with modifier 25), this is NOT considered a preventive service, and may be subject to deductibles, copays or coinsurance.
What about childhood immunizations?
Routine childhood immunizations recommended by the Advisory Committee on Immunization Practices are considered preventive services and are covered at 100 percent. Go to cdc.gov for more information.
However, if an associated problem-based office visit is billed, this is NOT considered a preventive service, and may be subject to deductibles, copays or coinsurance.How do I bill for adult preventive visits*
Step 1: Confirm that your services qualify as a preventive visit
By definition, a preventive visit is defined as an initial or periodic comprehensive preventive medicine (E/M) including:
** Age and gender appropriate history
** Examination
** Counseling/anticipatory guidance/risk factor reduction interventions
**Ordering of any necessary laboratory/diagnostic procedures
Step 2: Determine if your patient is a new or established patient Will my patient have any out-of-pocket cost*
Generally, no. All the above E/M codes, when accompanied by an appropriate diagnostic routine general medical exam code (such as Z00.00) are covered at 100 percent for patients with plan benefits that provide full coverage for preventive care.
However, if you bill an additional office visit code (for example, 15 minute expanded problem visit code 99213 with modifier 25), this is NOT considered a preventive service, and may be subject to deductibles, copays or coinsurance.
Are adult preventive visits the same thing as a Welcome to Medicare Visit or a Medicare Annual Wellness Visit* No. A Welcome to Medicare Visit (Initial Preventive Physical Exam) has specific components that must be met and is billed using code G0402:
** Initial preventive physical examination
** Face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment
A Medicare Annual Wellness Visit likewise has specific components that must be met, and is billed using code G0438 (first visit) or G0439 (subsequent visit).
** Annual wellness visit
** Includes a personalized prevention plan of service Visit medicare.gov for more information.
New pediatric patients Bill to Younger than one year old 99381 Age 1 – 4 years 99382 Age 5 – 11 years 99383 Age 12 – 17 years 99384 New adult patients Bill to Age 18 – 39 years 99385 Age 40 – 64 years 99386 Age 65 or older 99387 Established pediatric patients Bill to Same age groupings as above 99391 99392 99393 99394 Established adult patients Bill to Same age groupings as previous 99395 99396 99397
Recent Comments