Coverage Policy Manual
Policy #: 2011066
Category: PPACA Preventive
Initiated: October 2011
Last Review: January 2024
  PREVENTIVE SERVICES FOR NON-GRANDFATHERED (PPACA) PLANS: OVERVIEW
Description:
PREVENTIVE CARE SERVICES
Non-grandfathered/PPACA Wellness Summary
 
In 2011 and 2012, we had calls and questions on the differences between the pre PPACA wellness benefits and the PPACA wellness benefits for non-grandfathered health plans. We hope that the Preventive Care Services Summary that appeared in Provider News in August 2012 helped providers have a clearer understanding of the preventive services covered; these of course are subject to change. Portions of that article are included here. The preventive services component of the law was a requirement that all “non-grandfathered” health insurance plans are required to cover preventive medicine services given an “A” or “B” recommendation by the U.S. Preventive Services Task Force (USPSTF). ABCBS studied these recommendations and developed a coverage policy on each preventive medicine service; please refer to www.arkbluecross.com or www.heathadvantage-hmo.com.
 
In order to comply with the health care reform law (PPACA or the Patient Protection and Affordability Act), Women’s Preventive Services was added to many health plans. On August 1, 2012, the change was made to certain employer-sponsored health insurance plans. The change took place on January 1, 2013, for certain individual health plans.
 
We encourage each physician and other providers of preventive services to become familiar with the USPSTF, Bright Futures, and Women’s Health Initiative recommendations and ABCBS coverage policies. Most of the inquiries we received were on lab (urinalysis) and other services such as chest x-rays, electrocardiograms, breathing capacity tests, catheter for hysterography, vitamins, B-12 injections, cardiovascular stress tests, CT for bone density, CT for Head/Brain, Removing Ear Wax, Consultations, etc., that are not included in the USPSTF, Bright Futures, or Women’s Health Initiative recommendations for screening, and are not part of ABCBS coverage policy for non-grandfathered/PPACA Preventive Services. Claims for these services, if billed for screening, therefore would be provider write-offs as not meeting Primary Coverage Criteria or Not Medically Necessary, and are not member liability if billed with a preventive diagnosis unless the ordering provider has obtained from the member a signed waiver specifically stating why the requested service would not be covered.
 
Summary of Arkansas Blue Cross Blue Shield and Health Advantage Coverage Polices
The Federal Patient Protection and Preventive Care Act (PPACA) was passed by Congress and signed into law by the President in March 2010. The preventive services component of the law became effective September 23, 2010. A component of the law was a requirement that all “non-grandfathered” health insurance plans are required to cover those preventive medicine services given an “A” or “B” recommendation by the U.S. Preventive Services Task Force (USPSTF).
 
Plans are not required to provide coverage for the preventive services if they are delivered by out-of-network providers.
 
Task Force recommendations are graded on a five-point scale (A-E), reflecting the strength of evidence in support of the intervention. Grade A: There is good evidence to support the recommendation that the condition be specifically considered in a periodic health examination. Grade B: There is fair evidence to support the recommendation that the condition be specifically considered in a periodic health examination. Grade C: There is insufficient evidence to recommend for or against the inclusion of the condition in a periodic health examination, but recommendations may be made on other grounds. Grade D: There is fair evidence to support the recommendation that the condition be excluded from consideration in a periodic health examination. Grade E: There is good evidence to support the recommendation that the condition be excluded from consideration in a periodic health examination.
 
Those preventive medicine services listed as Grade A & B recommendations are covered without cost sharing (i.e., deductible, co-insurance, or co-pay) by Health Plans for appropriate preventive care services provided by an in-network provider. If the primary purpose for the office visit is for other than Grade A or B USPSTF preventive care services, deductible, co-insurance, or copay may be applied.
 
Services are typically included as part of a normal wellness visit; the appropriate office visit code should be used. Evaluation and Management codes for preventive services 99381-99397 will always be considered preventive. CPT Codes 99401-99404, when used to designate a preventive service, must have the applicable wellness/preventive diagnosis code as the primary reason for the visit.
 
Note: (99401-99404 are considered components of 99386-99387 if billed on the same date-of-service.)
 
When the primary purpose of the service is the delivery of an evidence-based service in accordance with a US Preventive Services Task Force A or B rating in effect and other preventive services identified in preventive services mandates (legislative or regulatory), the service may be billed with Modifier ‘-33’.
 
The correct coding as listed for both ICD 10 and CPT or HCPCS codes is also required along with Modifier 33.
  
For Self-funded plans with SPD language
Certain self-funded plans may have a different list of preventive care benefits. Please refer to the enrollee’s plan specific SPD for coverage. Group specific policy will supersede this policy when applicable. This policy does not apply to the Wal-Mart Associates Group Health Plan participants.
 
Note: Please encourage your patients to update their personal Health Record with information gathered during a preventive visit.
 
Note: The cost of drugs, medications, equipment, vitamins, or supplements that are recommended or prescribed for preventive measures are generally not covered as a preventive care benefit. Examples include, but are not limited to:
 
a. Aspirin for any indication, including but not limited to, aspirin for prevention of cardiovascular disease.
b. Supplements, including but not limited to, oral fluoride supplementation, and folic acid supplementation.
c. Tobacco cessation products or medications.
d. Electric Breast Pumps
Policy/
Coverage:
ABDOMINAL AORTIC ANEURYSM, SCREENING (Coverage Policy 2011011)
USPSTF Recommendation
The USPSTF recommends one-time screening for abdominal aortic aneurysm (AAA) with ultrasonography in men aged 65 - 75 years who have ever smoked. (Grade B)
CPT/HCPCS Codes:
CPT 76706
 
ALCOHOL AND DRUG MISUSE; COUNSELING AND/OR SCREENING (Coverage Policy 2011012)
USPSTF Recommendation
The USPSTF recommends screening for unhealthy alcohol use in primary care settings in adults 18 years or older, including pregnant women, and providing persons engaged in risky or hazardous drinking with brief behavioral counseling interventions to reduce unhealthy alcohol use. (Grade B)
The USPSTF recommends screening by asking questions about unhealthy drug use in adults age 18 years or older. (Grade B)
CPT/HCPCS Codes
CPT 99408
CPT 99409
HCPCS G0442
HCPCS G0443
 
ALCOHOL AND DRUG USE SCREENING FOR ADOLESCENTS BEGINNING AT AGE 11-21 (Coverage Policy 2011012)
HRSA (Bright Futures) Recommendation
Bright Futures recommends initiating questioning regarding alcohol or drug use and if positive, to follow with an alcohol or drug screening tool.
CPT/HCPCS Codes
CPT 99408
CPT 99409
HCPCS G0442
HCPCS G0443
(These codes are recommended by the AAP [Coding for Pediatric Preventive Care, 2011])
 
ANEMIA, SCREENING IN INFANTS, CHILDREN & ADOLESCENTS (Coverage Policy 2012036)
HRSA (Bright Futures) Recommendations
Hemoglobin & hematocrit should be screened for at the 4-month well-child visit in children who are preterm or who are low birth weight infants, and those not on iron-fortified formula.
Hemoglobin & hematocrit should be screened for routinely at the 12 month well-child visit.
Hemoglobin & hematocrit should be screened selectively for children who are positive for risk screening questions at the 15 month – 21 year visits.
CPT/HCPCS Codes
CPT 85014
CPT 85018
(These codes are recommended by the AAP [Coding for Pediatric Preventive Care, 2011])
 
AUTISM, SCREENING (Coverage Policy 2012045)
HRSA (Bright Futures) Recommendation
Provide the autism specific screening test at the 18 month and 24 month well child visits.
CPT/HCPCS Codes
CPT 96110
(This code is recommended by the AAP Coding for Pediatric Preventive Care, 2011)
HCPCS G0451
 
BACTERIURIA, SCREENING IN PREGNANT WOMEN (Coverage Policy 2011020)
USPSTF Recommendation
The USPSTF recommends screening for asymptomatic bacteriuria using urine culture in pregnant persons. (Grade B)
CPT/HCPCS Codes
CPT 87081
CPT 87084
CPT 87086
CPT 87088
 
BICYCLE HELMET USE FOR CHILDREN & ADOLESCENTS, COUNSELING FOR HRSA (Bright Futures) (Coverage Policy 2012044)
Give parents who do not require their children to use a helmet extensive information about the risks of bicycle –related head injuries, including the TIPP [AAP Injury Prevention Program] sheets and details of state or local legislation or regulations. Whenever available, provide discount coupons for approved helmets. Children who answer that they do not use a bicycle helmet should be given information appropriate to their age and cognitive level on the need for helmets.
(Performing Preventive Services: A Bright Futures Handbook)
CPT/HCPCS Codes
CPT 99381-99385
CPT 99391-99395
CPT 99401
(This code is recommended by the AAP [Coding for Pediatric Preventive Care, 2011])
(CPT 99401 is considered a component of 99381-99395 if billed on the same date-of-service [CPT-4 coding instructions])
 
BRCA TESTING, GENETIC COUNSELING AND EVALUATION (Coverage Policy 2011016)
USPSTF RECOMMENDATION
The USPSTF recommends that primary care clinicians assess women with a personal or family history of breast, ovarian, tubal, or peritoneal cancer or who have an ancestry associated with breast cancer susceptibility 1 and 2 (BRCA1/2) gene mutations with an appropriate brief familial risk assessment tool. Women with a positive result on the risk assessment tool should receive genetic counseling and, if indicated after counseling, genetic testing. (Grade B)
CPT/HCPCS Codes:
CPT 96040,
CPT 99401
CPT 99402
CPT 99403*
CPT 99404*
CPT 81212**
CPT 81215**
CPT 81216**
CPT 81217**
CPT 81162***
CPT 81163***
CPT 81164***
CPT 81165***
CPT 81166 ***
CPT 81167***
HCPCS S0265
*CPT 99403 and CPT 99404 require review of records.
(CPT 99401-99404 are considered components of 99386-99387 if billed on the same date-of-service [CPT-4 coding instructions])
**Coverage of these genetic testing codes will be effective May 1, 2013.
***Coverage of these genetic testing codes will be effective Jan 1, 2019.
 
BREAST CANCER, PREVENTIVE MEDICATION (Coverage Policy 2011017)
USPSTF Recommendation
The USPSTF recommends that clinicians offer to prescribe risk-reducing medications, such as tamoxifen, raloxifene, or aromatase inhibitors, to women who are at increased risk for breast cancer and at low risk for adverse medication effects. (Grade B)
CPT/HCPCS Codes
CPT 99385-99387
CPT 99395-99397
CPT 99401
CPT 99402
CPT 99403*
CPT 99404*
*CPT 99403 and CPT 99404 require review of records.
(CPT 99401-99404 are considered components of 99386-99387 if billed on the same date-of-service
[CPT-4 coding instructions])
HCPCS S0187
HCPCS S0170
HCPCS S0156
 
BREAST CANCER, SCREENING (MAMMOGRAPHY) (Coverage Policy 2011018)
USPSTF Recommendation
The USPSTF recommends biennial screening mammography for women aged 40 to 74 years. (Grade B)
HRSA Recommendation
The Women's Preventive Services Initiative recommends that average-risk women initiate mammography screening no earlier than age 40 and no later than age 50. Screening mammography should occur at least biennially and as frequently as annually. Screening should continue through at least age 74 and age alone should not be the basis to discontinue screening.
CPT/HCPCS Codes
CPT 77065
CPT 77066
CPT 77067
 
BREASTFEEDING, COUNSELING (Coverage Policy 2011019)
USPSTF Recommendation
The USPSTF recommends providing interventions during pregnancy and after birth to support breastfeeding. (Grade B)
HRSA Recommendation
WPSI recommends comprehensive lactation support services (including counseling, education, and breastfeeding equipment and supplies) during the antenatal, perinatal, and postpartum periods to ensure the successful initiation and maintenance of breastfeeding.
CPT/HCPCS Codes
CPT 99401
CPT 99402
CPT 99403*
CPT 99404*
HCPCS E0602
HCPCS E0603
HCPCS A4281
HCPCS A4282
HCPCS A4283
HCPCS A4284
HCPCS A4285
HCPCS A4286
HCPCS A4287
*CPT 99403 and CPT 99404 require review of records.
 
CARDIOMETABOLIC RISKS OF OBESITY IN CHILDREN AND ADOLESCENTS, COUNSELING (Coverage Policy 2012047)
HRSA (Bright Futures) Recommendation
Although Bright Futures does not include screening recommendations for this syndrome, the American Academy of Pediatrics (AAP) has issued a recent policy statement regarding lipid screening and cardiovascular health in childhood, which includes blood pressure assessment. Anticipatory guidance to help children maintain normal blood lipids and blood pressure—2 key components involved in metabolic syndrome—is a crucial part of preventive services for children and adolescents.
CPT Codes
CPT 99381
CPT 99382
CPT 99383
CPT 99384
CPT 99385
CPT 99391
CPT 99392
CPT 99393
CPT 99394
CPT 99395
 
CARDIOVASCULAR DISEASE PREVENTION, INTENSIVE BEHAVIORAL COUNSELING TO PROMOTE A HEALTHY DIET AND PHYSICAL ACTIVITY IN ADULTS WITH HIGH RISK FOR CARDIOVASCULAR DISEASE (Coverage Policy 2011034)
USPSTF Recommendation
The USPSTF recommends offering or referring adults with cardiovascular disease risk factors to behavioral counseling interventions to promote a healthy diet and physical activity. (Grade B)
CPT/HCPCS Codes:
97802-97803
99385-99387
99395-99397
99401-99404
G0108-G0109
G0270-G0271
G0473
S9140-S9141
S9452
S9455
S9460
S9465
S9470
 
CERVICAL CANCER AND HUMAN PAPILLOMAVIRUS (HPV) SCREENING (Coverage Policy 2011021)
USPSTF Recommendation
The USPSTF recommends screening for cervical cancer every 3 years with cervical cytology alone in women aged 21 to 29 years. For women aged 30 to 65 years, the USPSTF recommends screening every 3 years with cervical cytology alone, every 5 years with high-risk human papillomavirus (hrHPV) testing alone, or every 5 years with hrHPV testing in combination with cytology (cotesting). (Grade A)
HRSA (Bright Futures) Recommendation
Bright Futures recommends screening for cervical dysplasia at age 21.
HRSA (Women’s Preventive Service Guidelines) Recommendation
WPSI recommends cervical cancer screening for average-risk women aged 21 to 65 years. For women aged 21 to 29 years, the Women’s Preventive Services Initiative recommends cervical cancer screening using cervical cytology (Pap test) every 3 years. Cotesting with cytology and human papillomavirus testing is not recommended for women younger than 30 years. Women aged 30 to 65 years should be screened with cytology and human papillomavirus testing every 5 years or cytology alone every 3 years. Women who are at average risk should not be screened more than once every 3 years.
CPT/HCPCS Codes
CPT 87623-87625
CPT 88141-88143
CPT 88147-88148
CPT 88150, 88152-88153
CPT 88164-88167
CPT 88174-88175
HCPCS G0101
HCPCS G0123-G0124
HCPCS G0141
HCPCS G0143-G0145
HCPCS G0147-G0148
HCPCS G0476
P3000-P3001
Q0091
S0610
S0612
 
CHLAMYDIA INFECTION, SCREENING IN WOMEN & ADOLESCENTS (Coverage Policy 2011022)
USPSTF Recommendation
The USPSTF recommends screening for chlamydia in all sexually active women 24 years or younger and in women 25 years or older who are at increased risk for infection. (Grade B)
HRSA (Bright Futures) Recommendation
Screen sexually active adolescents between 11-21 years of age for chlamydia using tests appropriate to the patient population and clinical setting.
CPT/HCPCS Codes:
CPT 87270
CPT 87320
CPT 87490
CPT 87491
CPT 87800
CPT 87801
CPT 87810
 
COLORECTAL CANCER, SCREENING (Coverage Policy 2011045)
USPSTF Recommendation
The USPSTF recommends screening for colorectal cancer in all adults aged 50-75 years. (Grade A)
The USPSTF recommends screening for colorectal cancer in adults aged 45 to 49 years. (Grade B)
The USPSTF recommends the following stool-based and direct visualization screening tests: High-sensitivity gFOBT or FIT every year, sDNA-FIT every 3 years, CT colonography every 5 years, Flexible sigmoidoscopy every 5 years, Flexible sigmoidoscopy every 10 years with FIT every year, or Colonoscopy screening every 10 years
CPT/HCPCS Codes:
Use of the PT modifier with specific surgical codes will help identify the procedure as preventive; refer to coverage policy for coverage of polyp removal during a preventive service.
CPT 00812
CPT 45330
CPT 45331
CPT 45332
CPT 45333
CPT 45334
CPT 45335
CPT 45338
CPT 45346
CPT 45378
CPT 45379
CPT 45380
CPT 45381
CPT 45382
CPT 45384
CPT 45385
CPT 45388
CPT 74263
CPT 81528
CPT 82270
CPT 82274
CPT 88305
CPT 99153
HCPCS G0104
HCPCS G0105
HCPCS G0121
HCPCS G0328
HCPCS G0500
 
CONTRACEPTIVE USE & COUNSELING (Coverage Policy 2012035)
HRSA (Women’s Health Initiative) Recommendation
The Women’s Preventive Services Initiative (WPSI) recommends that adolescent and adult women have access to the full range of contraceptives and contraceptive care to prevent unintended pregnancies and improve birth outcomes. Contraceptive care includes screening, education, counseling, and provision of contraceptives (including in the immediate postpartum period). Contraceptive care also includes follow-up care (e.g., management, evaluation, and changes, including the removal, continuation, and discontinuation of contraceptives).
There is a $0 copayment for all generic prescription contraceptives. If there is no generic in the class/subclass, then brand contraceptive is at $0 copayment. Emergency contraceptives for members who are less than 18 years old for Plan B and those who are less than 17 years old for Plan B One-Step if they present a prescription for coverage.
CPT & HCPCS CODES
CPT 00851
CPT 11976
CPT 11980
CPT 11981
CPT 11982
CPT 11983
CPT 57170
CPT 58300
CPT 58301
CPT 58340
CPT 58600
CPT 58605
CPT 58611
CPT 58615
CPT 58670
CPT 58671
CPT 74740
CPT 96372
CPT 99201
CPT 99202
CPT 99203
CPT 99204
CPT 99205
CPT 99212
CPT 99213
CPT 99214
CPT 99215
CPT 99384
CPT 99385
CPT 99386
CPT 99394
CPT 99395
CPT 99396
HCPCS G0438
HCPCS G0439
HCPCS S4981
HCPCS S4989
HCPCS S4993
HCPCS A4261
HCPCS A4266
HCPCS A4267
HCPCS A4268
HCPCS A4269
HCPCS J1050
HCPCS J7294
HCPCS J7295
HCPCS J7296
HCPCS J7297
HCPCS J7298
HCPCS J7300
HCPCS J7301
HCPCS J7303
HCPCS J7304
HCPCS J7306
HCPCS J7307
 
DENTAL CARIES IN PRESCHOOL CHILDREN (Coverage Policy 2011029)
USPSTF Recommendation
The USPSTF recommends that primary care clinicians apply fluoride varnish to the primary teeth of all infants and children starting at the age of primary tooth eruption (Grade B).
The USPSTF recommends that primary care clinicians prescribe oral fluoride supplementation starting at age 6 months for children whose primary water supply is deficient in fluoride. (Grade B)
HRSA (Bright Futures) Recommendation
Oral fluoride supplementation if the primary water source is deficient in fluoride at 6mos, 9 mos, 12 mos, 18 mos, 24 months, 30 mos, and yearly from 3 years to 16 years.
Once teeth are present, apply fluoride varnish every 3 to 6 months in the primary care or dental office based on caries risk through 5 years of age.
CPT HCPCS Codes:
CPT 99381-99383
CPT 99391-99393
CPT 99188
 
DEPRESSION AND ANXIETY, SCREENING IN ADULTS (Coverage Policy 2011043)
USPSTF Recommendation
The USPSTF recommends screening in the general adult population, including pregnant and postpartum women. Screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up. (Grade B)
HRSA Recommendation
WPSI recommends screening for anxiety in adolescent and adult women, including those who are pregnant or postpartum.
CPT/HCPCS Codes:
CPT 96127
CPT 96160
CPT 96161
CPT 99385-99387
CPT 99395-99397
CPT 99401-99404
HCPCS G0444
 
DEPRESSION AND ANXIETY, SCREENING IN ADOLESCENTS (Coverage Policy 2011044)
USPSTF Recommendation
The USPSTF recommends screening for major depressive disorder (MDD) in adolescents aged 12 to 18 years. Screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up. (Grade B)
The USPSTF recommends screening for anxiety in children and adolescents aged 8 to 18 years. (Grade B)
HRSA Recommendation
WPSI recommends screening for anxiety in adolescent and adult women, including those who are pregnant or postpartum.
CPT/HCPCS Codes:
CPT 96127
CPT 96160
CPT 96161
CPT 99383-99385
CPT 99393-99395
CPT 99401-99404
HCPCS G0444
 
DEVELOPMENTAL SCREENING (Coverage Policy 2012048)
HRSA (Bright Futures) Recommendation
Begin structured developmental screening at the 9 month well child visit with repeat evaluation at the 18 month and the 2½ year well child visits.
CPT/HCPCS Codes
CPT 96110
(This code is recommended by the AAP (Coding for Pediatric Preventive Care, 2011])
CPT 96127
HCPCS G0451
 
DIABETES MELLITUS, TYPE 2, SCREENING IN ADULTS (Coverage Policy 2011026)
USPSTF Recommendation
The USPSTF recommends screening for prediabetes and type 2 diabetes in adults aged 35 to 70 years who have overweight or obesity. Clinicians should offer or refer patients with prediabetes to effective preventive interventions. (Grade B)
CPT/HCPCS Codes
CPT 82947
CPT 82950
CPT 82951
CPT 82952
CPT 83036
CPT 99401
CPT 99402
CPT 99403
CPT 99404
HCPCS G0447
HCPCS G0473
 
DIABETES MELLITUS, GESTATIONAL AND POSTPARTUM SCREENING (Coverage Policy 2012032)
HRSA (Women’s Preventive Services Initiative) Recommendation
The Women’s Preventive Services Initiative recommends screening pregnant women for gestational diabetes mellitus after 24 weeks of gestation (preferably between 24 and 28 weeks of gestation) in order to prevent adverse birth outcomes.
The Women’s Preventive Services Initiative recommends screening pregnant women with risk factors for type 2 diabetes or GDM before 24 weeks of gestation—ideally at the first prenatal visit.
WPSI recommends screening for type 2 diabetes in women with a history of gestational diabetes mellitus (GDM) who are not currently pregnant and who have not previously been diagnosed with type 2 diabetes. Initial testing should ideally occur within the first year postpartum and can be conducted as early as 4–6 weeks postpartum.
Women who are not screened in the first year postpartum or those with a negative initial postpartum screening test result should be rescreened at least every 3 years for a minimum of 10 years after pregnancy. For those with a positive postpartum screening test result in the early postpartum period, testing should be repeated at least 6 months postpartum to confirm the diagnosis of diabetes regardless of the initial test (e.g., oral glucose tolerance test, fasting plasma glucose, or hemoglobin A1c).
Repeat testing is also indicated in women screened with hemoglobin A1c in the first 6 months postpartum regardless of whether the test results are positive or negative because the hemoglobin A1c test is less accurate during the first 6 months postpartum.
USPSTF Recommendation
The USPSTF recommends screening for gestational diabetes in asymptomatic pregnant persons at 24 weeks of gestation or after. (Grade B)
CPT/HCPCS Codes
CPT 82947
CPT 82950
CPT 82951
CPT 82952
CPT 83036
 
FALLS, PREVENTION IN COMMUNITY-DWELLING OLDER ADULTS (Coverage Policy 2012055)
USPSTF Recommendation
The USPSTF recommends exercise interventions to prevent falls in community-dwelling adults aged 65 years or older who are at increased risk for falls. (Grade B).
CPT/HCPCS Codes
CPT 97001
CPT 97002
CPT 97110
CPT 97112
CPT 97116
CPT 97750
HCPCS G0159
HCPCS S9131
 
FOLIC ACID, PREVENTION OF NEURAL TUBE DEFECTS (Coverage Policy 2011041)
USPSTF Recommendation
The USPSTF recommends that all women who are planning or capable of pregnancy take a daily supplement containing 0.4 to 0.8 mg (400 to 800 µg) of folic acid. (Grade A)
CPT/HCPCS Codes
Information on folic acid is typically provided during an office visit.
 
GONORRHEA, PROPHYLAXIS, NEWBORN OPHTHALMIC (Coverage Policy 2011035)
USPSTF Recommendation
The USPSTF recommends prophylactic ocular topical medication for all newborns to prevent gonococcal ophthalmia neonatorum. (Grade A)
CPT/HCPCS Code:
CPT 99461
CPT 99381
 
GONORRHEA, SCREENING (Coverage Policy 2011038)
USPSTF Recommendation
The USPSTF recommends screening for gonorrhea in all sexually active women 24 years or younger and in women 25 years or older who are at increased risk for infection. (Grade B)
HRSA (Bright Futures) Recommendation
Screen sexually active adolescents between 11-21 years of age using tests appropriate to the patient population and clinical setting.
CPT/HCPCS Codes:
CPT 87590
CPT 87591
CPT 87800
CPT 87801
CPT 87850
 
HEARING LOSS, SCREENING IN NEWBORNS AND UP TO AGE 21 (Coverage Policy 2011036)
USPSTF Recommendation
The USPSTF recommends screening for hearing loss in all newborn infants. (Grade B)
HRSA (Bright Futures) Recommendation
If not done at birth (e.g., newborn delivered at home or discharged from Neonatal Intensive Care Unit) screening should be completed within the first month of life.
After the 4th month, if there are positive responses to risk screening questions, the infant should be referred for diagnostic audiologic assessment.
At years 4, 5, 6, 8, and 10, audiometry is recommended, universally. Otherwise, audiometry screening is recommended once during the early adolescence years (11-14), once during the middle adolescence years (15-17), and once during the late adolescence years (18-21).
CPT HCPCS Codes:
CPT 92551
CPT 92552
CPT 92558
CPT 92567
CPT 92579
CPT 92582
 
HEPATITIS B VIRUS SCREENING (Coverage Policy 2011039)
USPSTF Recommendation
The USPSTF recommends screening for hepatitis B virus (HBV) infection in adolescents and adults at increased risk for infection. (Grade B)
The USPSTF recommends screening for hepatitis B virus infection in pregnant women at their first prenatal visit (Grade A)
CPT/HCPCS Codes:
CPT 80055
CPT 80081
CPT 87340
CPT G0499
 
HEPATITIS C VIRUS SCREENING (Coverage Policy 2013023)
The USPSTF recommends screening for hepatitis C virus (HCV) infection in adults aged 18 to 79 years (Grade B).
CPT/HCPCS Codes:
CPT 86803
CPT 87521
HCPCS G0472
 
HIGH BLOOD PRESSURE, SCREENING IN ADULTS (Coverage Policy 2011015)
USPSTF Recommendation
The USPSTF recommends screening for hypertension in adults 18 years or older with office blood pressure measurement (OBPM). The USPSTF recommends obtaining blood pressure measurements outside of the clinical setting for diagnostic confirmation before starting treatment. (Grade A)
CPT/HCPCS Codes
CPT 99385-99387
CPT 99395-99397
 
HIGH BLOOD PRESSURE, SCREENING IN INFANTS, CHILDREN & ADOLESCENTS (Coverage Policy 2012037)
HRSA (Bright Futures) Recommendation
Infants & children with specific risk factors for high blood pressure should be screened up through age 2½; blood pressure examination is included in the complete physical examination done routinely after 2½.
CPT/HCPCS Codes
CPT 99381-99384
CPT 99391-99394
 
HUMAN IMMUNODEFICIENCY VIRUS (HIV), COUNSELING AND SCREENING (Coverage Policy 2011040)
USPSTF Recommendation
The USPSTF recommends that clinicians screen for HIV infection in adolescents and adults aged 15 to 65 years. Younger adolescents and older adults who are at increased risk of infection should also be screened. (Grade A)
The USPSTF recommends that clinicians screen for HIV infection in all pregnant persons, including those who present in labor or at delivery whose HIV status is unknown. (Grade A)
HRSA (Bright Futures) Recommendation
Adolescents between the ages of 11-14 who are at increased risk of infection should be screened for HIV. Adolescents aged 15 and older should receive a screening test for HIV.
HRSA (Women’s Health Initiative) Recommendation
WPSI recommends all adolescent and adult women, ages 15 and older, receive a screening test for HIV at least once during their lifetime. Earlier or additional screening should be based on risk, and rescreening annually or more often may be appropriate at age 13 for adolescent and adult women with an increased risk of HIV infection.
WPSI recommends risk assessment and preventive education for HIV infection beginning at age 13 and continuing as determined by risk. A screening test for HIV is recommended for all pregnant women upon initiation of prenatal care with rescreening during pregnancy based on risk factors. Rapid HIV testing is recommended for pregnant women who present in active labor with an undocumented HIV status.
Screening will be allowed up to 3 times per year
CPT/HCPCS Codes:
CPT 86689
CPT 86701
CPT 86703
CPT 87389
CPT 87390
CPT 87535
CPT 87806
CPT 99401
CPT 99402
CPT 99403*
CPT 99404*
*CPT 99403 and CPT 99404 require review of records.
HCPCS G0432
HCPCS G0433
HCPCS G0435
HCPCS S3645
 
Human Immunodeficiency Virus (HIV) Infection, Prevention of: Preexposure Prophylaxis (Coverage Policy 2022028)
USPSTF Recommendation
The USPSTF recommends that clinicians offer preexposure prophylaxis (PrEP) with effective antiretroviral therapy to persons who are at high risk of HIV acquisition. (Grade A) Note: Check pharmacy benefit for specifics related to coverage of antiretroviral therapy medications.
CPT/HCPCS Codes
CPT 81025
CPT 82565
CPT 82570
CPT 82575
CPT 86592
CPT 86689
CPT 86701-86703
CPT 86803
CPT 87270
CPT 87320
CPT 87340
CPT 87389-87390
CPT 87490-87491
CPT 87521
CPT 87535
CPT 87590-87592
CPT 87800-87801
CPT 87806
CPT 87808
CPT 87810
CPT 87850
CPT 99211-99215
CPT 99401-99404
HCPCS G0432-G0433
HCPCS G0435
HCPCS G0445
HCPCS G0472
HCPCS G0499
HCPCS J0750
HCPCS J0751
HCPCS J0799
HCPCS Q0516
HCPCS Q0517
HCPCS Q0518
HCPCS Q0519
HCPCS Q0520
HCPCS S3645
 
INTIMATE PARTNER, INTERPERSONAL, AND DOMESTIC VIOLENCE, SCREENING/COUNSELING OF WOMEN AND ADOLESCENTS, ANNUALLY (Coverage Policy 2012021)
USPSTF Recommendation
The USPSTF recommends that clinicians screen for intimate partner violence (IPV) in women of reproductive age and provide or refer women who screen positive to ongoing support services. (Grade B)
HRSA (Women’s Health Initiative) Recommendation
The Women’s Preventive Services Initiative recommends screening adolescents and women for interpersonal and domestic violence, at least annually, and, when needed, providing or referring for initial intervention services.
CPT/HCPCS Codes
CPT 99384-99387
CPT 99394-99397
CPT 99401
CPT 99402
CPT 99403*
CPT 99404*
*CPT 99403 and CPT 99404 require review of records.
(CPT 99401-99404 are considered components of 99381-99397 if billed on the same date-of-service [CPT-4 coding instructions])
 
LEAD SCREENING IN INFANTS AND CHILDREN THROUGH AGE 6 (Coverage Policy 2012038)
HRSA (Bright Futures) Recommendation
A risk assessment should be done at the following well-child visits: 6 months, 9 months, 12 months (low prevalence area, not on Medicaid), 18 months, 24 months (low prevalence area, not on Medicaid), and at 3, 4, 5, and 6 years of age. A screening should be done at the 12 month and 24 month visit based on universal screening requirements for individuals with Medicaid or in high prevalence areas.
CPT/HCPCS Codes
CPT 83655
 
LIPID (CHOLESTEROL) SCREENING AND STATIN USE (Coverage Policy 2011010)
USPSTF Recommendations
The USPSTF recommends that clinicians prescribe a statin for the primary prevention of CVD for adults aged 40 to 75 years who have 1 or more CVD risk factors (i.e. dyslipidemia, diabetes, hypertension, or smoking) and an estimated 10-year risk of a cardiovascular event of 10% or greater. (Grade B)
HRSA (Bright Futures) Recommendation
A fasting lipoprotein profile (total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglyceride) should be obtained before pubertal onset (once between the ages of 9-11) and in late adolescence (once between the ages of 17-21). Screening should be considered for younger children when a history of familial hypercholesterolemia has been identified. Risk assessments should be done at the ages of 2, 4, 6, and 8. A total of 2 fasting lipids should be obtained at these ages for children who test positive on risk screening questions. A risk assessment should also be done at 12-16 years of age. A total of 2 fasting lipids should be obtained for adolescents between the ages of 12-16 who test positive to risk screening questions.
CPT/HCPCS Codes:
CPT 80061
CPT 82465
CPT 83718
 
LUNG CANCER SCREENING (Coverage Policy 2014020)
USPSTF Recommendation
The USPSTF recommends annual screening for lung cancer with low-dose computed tomography in adults ages 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years. Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery (Grade B.).
CPT/HCPCS Codes:
71271
 
MEDIA USE BY CHILDREN & ADOLESCENTS, SCREENING & COUNSELING FOR (Coverage Policy 2012042)
HRSA (BRIGHT FUTURES) Recommendation
Screening:
To screen for media usage, clinicians should ask 2 questions about media use at health supervision visits:
1) How much screen time per day does the child spend?
2) Is there a TV set or Internet connection in the child’s bedroom?
Counseling:
Since they potentially influence numerous aspects of child and adolescent health, the media may represent the most important area of anticipatory guidance in well-child visits. One study has shown that a minute or two of office counseling about media violence and guns could reduce violence exposure for nearly 1 million children per year. Given the sheer number of hours that children spend with media, counseling is imperative.
CPT/HCPCS Codes
CPT 99382
CPT 99383
CPT 99384
CPT 99385
CPT 99392
CPT 99393
CPT 99394
CPT 99395
 
NEWBORN SCREENING FOR INHERITED DISORDERS (Coverage Policy 2012040)
HRSA (Bright Futures) Recommendation
Conduct screening as required by the state. (Arkansas statute requires newborn screening for metabolic (inborn errors of metabolism) and hemoglobinopathies); the tests are usually done prior to discharge from the hospital following birth of the infant).
CPT/HCPCS Codes
S3620
 
OBESITY IN ADULTS AND CHILDREN; SCREENING AND COUNSELING (Coverage Policies 2011025 and 2011030)
USPSTF Recommendation
The USPSTF recommends that clinicians offer or refer adults with a body mass index (BMI) of 30 or higher (calculated as weight in kilograms divided by height in meters squared) to intensive, multicomponent behavioral interventions. (Grade B)
The USPSTF recommends that clinicians screen for obesity in children and adolescents 6 years and older and offer or refer them to comprehensive, intensive behavioral interventions to promote improvements in weight status. (Grade B)
Bright Futures
Bright Futures recommends screening with BMI annually beginning at 2 years of age. Recommend referral for counseling to support healthy nutrition and physical activity for children and adolescents 2 years of age and older whose BMI is at or above the 85th percentile for age and sex.
CPT/HCPCS Codes
CPT 99383-99387
CPT 99393-99397
CPT 99401
CPT 99402
CPT 99403*
CPT 99404*
HCPCS G0447
HCPCS G0473
*CPT 99403 and CPT 99404 require review of records
(CPT 99401 – 99404 are considered components of 99381 or 99397 if billed on the same date-of-service [CPT-4 coding instructions])
 
OSTEOPOROSIS SCREENING IN WOMEN (Coverage Policy 2011031)
USPSTF Recommendation
The USPSTF recommends screening for osteoporosis with bone measurement testing to prevent osteoporotic fractures in women age 65 and older. The USPSTF recommends screening for osteoporosis with bone measurement testing to prevent osteoporotic fractures in postmenopausal women younger than 65 years who are at increased risk of osteoporosis, as determined by a formal clinical risk assessment tool (Grade B).
CPT/HCPCS Codes
CPT 77080
 
PHENYLKETONURIA SCREENING IN NEWBORNS (Coverage Policy 2011028)
USPSTF Recommendation
The USPSTF recommends screening for phenylketonuria (PKU) in newborns. (Grade A)
HRSA (Bright Futures) Recommendation
Conduct screening as required by the state. (Arkansas statute requires newborn screening for phenylketonuria; this test is usually done prior to discharge from the hospital following birth of the infant).
CPT/HCPCS Code
CPT 84030
 
PREECLAMPSIA, PREVENTION AND TREATMENT OF PREECLAMPSIA IN PREGNANT WOMEN (Coverage Policy 2015036)
USPSTF Recommendation
The USPSTF recommends screening for preeclampsia in pregnant women with blood pressure measurements throughout pregnancy. (Grade B)
The USPSTF recommends the use of low-dose aspirin (81 mg/day) as preventive medication after 12 weeks of gestation in persons who are at high risk for preeclampsia. (Grade B)
CPT/HCPCS Codes:
CPT 99384-99386
CPT 99394-99396
CPT 99401-99404
 
PREGNANCY, SCREENING, IN SEXUALLY ACTIVE FEMALES WITHOUT CONTRACEPTION, LATE MENSES, OR AMENORRHEA (Coverage Policy 2012041)
HRSA (Bright Futures) Recommendation
The USPSTF recommends screening for pregnancy with urine human chorionic gonadotrophin in sexually active females who do not practice contraception, who have late menses, or amenorrhea, ages 11 to 21.
CPT/HCPCS Codes
CPT 81025
CPT 84703
 
RH INCOMPATABILITY SCREENING (Coverage Policy 2011027)
USPSTF Recommendations
The USPSTF strongly recommends Rh (D) blood typing and antibody testing for all pregnant women during their first visit for pregnancy-related care.(Grade A)
The USPSTF recommends repeated Rh (D) antibody testing for all unsensitized Rh (D)-negative women at 24-28 weeks' gestation, unless the biological father is known to be Rh (D)-negative. (Grade B)
CPT/HCPCS Codes:
CPT 80055
CPT 86901
 
SEXUALLY TRANSMITTED INFECTIONS (STIs); BEHAVIORAL COUNSELING FOR PREVENTION (Coverage Policy 2011032)
USPSTF Recommendation
The USPSTF recommends behavioral counseling for all sexually active adolescents and for adults who are at increased risk for sexually transmitted infections (STIs). (Grade B)
HRSA (Women’s Preventive Service Initiative) Recommendation
The Women’s Preventive Service Initiative recommends directed behavioral counseling by a health care provider or other appropriately trained individual for sexually active adolescent and adult women at an increased risk for STIs.
Bright Futures Recommendation
Bright Futures recommends screening for STIs in all sexually active adolescents.
CPT/HCPCS Codes
CPT 99401
CPT 99402
CPT 99403*
CPT 99404*
HCPCS G0445
*CPT 99403 and CPT 99404 require review of records.
 
SKIN CANCER COUNSELING (Coverage Policy 2012018)
USPSTF Recommendation
The USPSTF recommends counseling young adults, adolescents, children, and parents of young children about minimizing exposure to ultraviolet (UV) radiation for persons aged 6 months to 24 years with fair skin types to reduce their risk of skin cancer. (Grade B)
CPT/HCPCS Codes
CPT 99381
CPT 99382
CPT 99383
CPT 99384
CPT 99385
CPT 99391
CPT 99392
CPT 99393
CPT 99394
CPT 99395
 
SYPHILIS, SCREENING (Coverage Policy 2011037)
USPSTF Recommendation
The USPSTF recommends that clinicians screen all persons at increased risk for syphilis infection, and all pregnant women for syphilis infection. (Grade A)
HRSA (Bright Futures) Recommendation
Bright Futures recommends screening for syphilis in all adolescents who are sexually active and positive for high risk.
CPT/HCPCS Codes:
CPT 80055
CPT 86592
CPT 86780
 
TOBACCO USE, SCREENING, COUNSELING AND INTERVENTIONS (Coverage Policy 2011024)
USPSTF Recommendation
The USPSTF recommends that clinicians ask all adults about tobacco use, advise them to stop using tobacco, and provide behavioral interventions and U.S. Food and Drug Administration (FDA)-approved pharmacotherapy for cessation to nonpregnant adults who use tobacco. (Grade A)
The USPSTF recommends that clinicians ask all pregnant persons about tobacco use, advise them to stop using tobacco, and provide behavioral interventions for cessation to pregnant persons who use tobacco. (Grade A)
The USPSTF recommends that primary care clinicians provide interventions, including education or brief counseling, to prevent initiation of tobacco use among school-aged children and adolescents. (Grade B)
HRSA (Bright Futures) Recommendation
Bright Futures recommends that health care professionals screen for tobacco use and tobacco smoke exposure, encourage tobacco use cessation, and provide tobacco use cessation strategies and resources at most visits for school aged children and adolescents ages 5 years and older..
CPT/HCPCS Codes:
CPT 99406
CPT 99407
 
TUBERCULOSIS, SCREENING (Coverage Policy 2012039)
USPSTF Recommendation
The USPSTF recommends screening for latent tuberculosis infection (LTBI) in populations at increased risk. (Grade B)
HRSA (Bright Futures) Recommendation
Begin selective screening for tuberculosis with the tuberculin skin test for infants, children, and adolescents who are at increased risk based on risk screening questions, at the first month well-child visit and continue through adolescence.
CPT/HCPCS Codes
CPT 86480
CPT 86580
 
VISUAL IMPAIRMENT, SCREENING IN CHILDREN (Coverage Policy 2011033)
USPSTF Recommendation
The USPSTF recommends vision screening for all children at least once between the ages of 3 and 5 years, to detect the presence of amblyopia or its risk factors (Grade B)
HRSA (Bright Futures) Recommendation
A visual acuity screen is recommended at ages 4 and 5 years, as well as in cooperative 3-year-olds. Instrument-based screening may be used to assess risk at ages 12 and 24 months, in addition to the well visits at 3 through 5 years of age.
CPT/HCPS Code
CPT 99173
CPT 99174
CPT 99177
 
WELL-CHILD VISITS, NEWBORN, INFANT, CHILDREN, ADOLESENTS, & AGES 18-21 (Coverage Policy 2012046)
HRSA (Bright Futures) Recommendation
Bright Futures recommends well child visits at birth, first week after birth, at age 1 month, 2 months, 4 months, 6 months, 9 months, 1 year, 15 months, 18 months, 2 years, 2½ years, 3 years, and then annually through the age of 21 years.
Coverage for these visits are similar to that required by Arkansas Statute.
CPT/HCPCS
CPT 96127
CPT 96160
CPT 96161
CPT 99381 - 99385
CPT 99391 – 99395
 
WELL WOMAN VISIT FOR ADOLESCENT AND ADULT WOMEN (Coverage Policy 2012031)
HRSA (Women’s Health Initiative)
WPSI recommends that women receive at least one preventive care visit per year beginning in adolescence and continuing across the lifespan to ensure the provision of all recommended preventive services, including preconception and many services necessary for prenatal and interconception care, are obtained. The primary purpose of these visits should be the delivery and coordination of recommended preventive services as determined by age and risk factors. These services may be completed at a single or as part of a series of visits that take place over time to obtain all necessary services depending on a woman’s age, health status, reproductive health needs, pregnancy status, and risk factors. Well-women visits also include prepregnancy, prenatal, postpartum and interpregnancy visits.
WPSI recommends counseling midlife women aged 40 to 60 years with normal or overweight body mass index (BMI) (18.5-29.9 kg/m2) to maintain weight or limit weight gain to prevent obesity. Counseling may include individualized discussion of healthy eating and physical activity.
CPT/HCPCS Codes
CPT 59425
CPT 59426
CPT 59430
CPT 99383
CPT 99384
CPT 99385
CPT 99386
CPT 99387
CPT 99393
CPT 99394
CPT 99395
CPT 99396
CPT 99397
CPT 99459
HCPCS G0101
HCPCS G0438
HCPCS G0439
HCPCS S0610
HCPCS S0612
 
Other Preventive Services
 
ACIP Immunizations Recommendations
An immunization that does not fall under one of the exclusions in the Certificate of Coverage is considered covered after all of the following conditions are satisfied: (1) FDA approval; (2) explicit ACIP recommendation published in the Morbidity & Mortality Weekly Report (MMWR) of the Centers for Disease Control and Prevention (CDC). Implementation will typically occur within 60 days after publication in the MMWR.
 
Immunization Administration Codes:
CPT 90460
CPT 90461
CPT 90471
CPT 90472
CPT 90473
CPT 90474
HCPCS G0008
HCPCS G0009
HCPCS G0010
 
Immunization/Vaccine Codes
CPT 90380 For all infants younger than 8 months born during or entering their first RSV season and infants and children aged 8-19 months who are at increased risk of severe RSV disease entering their second RSV season (Effective 8/25/2023) AND
CPT 90381 For all infants younger than 8 months born during or entering their first RSV season and infants and children aged 8-19 months who are at increased risk of severe RSV disease entering their second RSV season. (Effective 8/25/2023)
CPT 90396 (Appropriate ICD-10 is Z23)
CPT 90581 Only for Very Select Persons Who Meet Specific Criteria
CPT 90587 For ages 9-16 years having evidence of a previous dengue infection and living in areas where dengue is endemic
CPT 90619
CPT 90620
CPT 90621
CPT 90623 (Appropriate ICD-10 is Z23)
CPT 90630 (Only for persons aged 18 through 64 yr. Appropriate ICD-10 is Z23)
CPT 90632 (Appropriate ICD-10 is Z23)
CPT 90633 (Appropriate ICD-10 is Z23)
CPT 90636 (Appropriate ICD-10 is Z23) Limited to 4 units per lifetime
CPT 90644
CPT 90647 (Appropriate ICD-10 is Z23)
CPT 90648 (Appropriate ICD-10 is Z23)
CPT 90649 Note: coverage for 90649 is limited to adolescents and adults ages 9 – 26 and some adults aged 27-45 who are not adequately vaccinated. (Appropriate ICD-10 is Z23)
CPT 90650 Note: coverage for 90650 is limited to females age 9 – 26, and some female adults aged 27-45 who are not adequately vaccinated. (Appropriate ICD-10 is Z23)
CPT 90651 Note: coverage for 90651 is limited to adolescents and adults ages 9 – 26, and some adults aged 27-45 who are not adequately vaccinated..
CPT 90653 Note: coverage for 90653 is limited to persons 65 years of age or older
CPT 90655 (Appropriate ICD-10 is Z23)
CPT 90656 (Appropriate ICD-10 is Z23)
CPT 90657 (Appropriate ICD-10 is Z23)
CPT 90658 (Appropriate ICD-10 is Z23)
CPT 90660 Note: coverage is limited to ages 2 – 49 (Appropriate ICD-10 is Z23)
CPT 90661
CPT 90662
CPT 90670 (Appropriate ICD-10 is Z23)
CPT 90671 (Appropriate ICD-10 is Z23) Subject to the recommendation of the Advisory Committee on Immunization Practices (ACIP).
CPT 90672 (Effective 6/2018)
CPT 90673 (Only for persons age 18 years or older)
CPT 90674 (Only for persons 6 months of age or older)
CPT 90677 (Appropriate ICD 10 is Z23) Subject to the recommendation of the Advisory Committee on Immunization Practices (ACIP).
CPT 90678 Note: Coverage for 90678 is limited to a single dose for pregnant persons at 32-36 weeks gestation (Effective October 6, 2023) AND all adults age 75 and older AND adults age 60-74 who are at increased risk for severe RSV (Effective August 15, 2024) (Appropriate ICD 10 is Z23)
CPT 90679 Note: Coverage for 90679 is limited to a single dose for all adults age 75 and older AND adults age 60-74 who are at increased risk for severe RSV (Effective August 15, 2024) (Appropriate ICD 10 is Z23)
CPT 90680 Note: Coverage for 90680 is limited to a single dose for all adults age 75 and older AND adults age 60-74 who are at increased risk for severe RSV (Effective August 15, 2024) (Appropriate ICD 10 is Z23)
CPT 90681 (Appropriate ICD-10 is Z23)
CPT 90682
CPT 90683 Note: Coverage for 90683 is limited to a single dose for all adults age 75 and older AND adults age 60-74 who are at increased risk for severe RSV (Effective August 15, 2024) (Appropriate ICD 10 is Z23)
CPT 90684 (Appropriate ICD-1 is Z23)
CPT 90685 (Appropriate ICD-10 is Z23)
CPT 90686 (Appropriate ICD-10 is Z23)
CPT 90687 (Only for persons aged greater than or equal to 6 mos. to 35 mos. Appropriate ICD-10 is Z23)
CPT 90688 (Only for persons aged greater than or equal 3 yrs. Appropriate ICD-10 is Z23)
CPT 90689 (Appropriate ICD-10 is Z23)
CPT 90694 (Appropriate ICD-10 is Z23)
CPT 90696 Children 4-6 years of age Only. (Appropriate ICD-10 is Z23).
CPT 90697 Children 6 weeks through 4 years (Appropriate ICD-10 is Z23)
CPT 90698 Infants & Children Only less than 6 (Appropriate ICD-10 is Z23).
CPT 90700 (Appropriate ICD-10 is Z23).
CPT 90702
CPT 90707 (Appropriate ICD-10 is Z23).
CPT 90710 (Appropriate ICD-10 is Z23)
CPT 90712 Only for Very Select Children, Adolescents, or Adults who meet certain criteria. (Appropriate ICD-10 is Z23).
CPT 90713 (Appropriate ICD-10 is Z23).
CPT 90714 (Appropriate ICD-10 is Z23).
CPT 90715 (Appropriate ICD-10 is Z23).
CPT 90716 (Appropriate ICD-10 is Z23).
CPT 90718 (Appropriate ICD-10 is Z23).
CPT 90723
CPT 90732 (Appropriate ICD-10 is Z23).
CPT 90733 (Appropriate ICD-10 is Z23).
CPT 90734 (Appropriate ICD-10 is Z23).
CPT 90739 (Appropriate ICD-10 is Z23) Limited to 4 units per lifetime
CPT 90740
CPT 90743 (Appropriate ICD-10 is Z23)
CPT 90744 (Appropriate ICD-10 is Z23)
CPT 90746 (Appropriate ICD-10 is Z23) Limited to 4 units per lifetime
CPT 90747 (Appropriate ICD-10 is Z23)
CPT 90748 (Appropriate ICD-10 is Z23).
CPT 90749
CPT 90750 Only for age 19 and older with immunodeficiency or immunosuppression (effective January 21, 2022) or adults age 50 years and older (Appropriate ICD-10 is Z23).
CPT 90756
CPT 90759 (Effective 04/01/2022)
CPT 90480 (Effective 09/12/2023) (Appropriate ICD-10 is Z23)
CPT 91304 For ages 12 years and older (Effective 10/03/2023) (Appropriate ICD-10 is Z23)
CPT 91318 Only for ages 6 months to 4 years (Effective 09/12/2023) (Appropriate ICD-10 is Z23)
CPT 91319 Only for ages 5 through 11 years (Effective 09/12/2023) (Appropriate ICD-10 is Z23)
CPT 91320 For ages 12 years and older (Effective 09/12/2023) (Appropriate ICD-10 is Z23)
CPT 91321 Only for ages 6 months through 11 years (Effective 09/12/2023) (Appropriate ICD-10 is Z23)
CPT 91322 For ages 12 years and older (Effective 09/12/2023) (Appropriate ICD-10 is Z23)
CPT 96380 (Effective 10/6/2023)
CPT 96381 (Effective 10/6/2023)
 
PROSTATE CANCER SCREENING
Arkansas State Mandate
Act 75 of 2009 requires payment for prostate cancer screening annually for men age 40 and over as recommended by the National Comprehensive Cancer Network effective January 2009.
CPT/HCPCS Codes
CPT 84153
CPT 84154
HCPCS G0102
HCPCS G0103
 
MISCELLANEOUS PROCEDURES COVERED UNDER WELLNESS, BUT NOT LISTED UNDER PPACA, allowed only once a year in conjunction with an annual wellness exam
CPT/HCPCS Codes
CPT 99385
CPT 99386
CPT 99387
CPT 99395
CPT 99396
CPT 99397
CPT 80050
CPT 81000
CPT 81001
CPT 81002
CPT 81003
Rationale:
ACIP recommendations
CPT/HCPCS:
00812Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; screening colonoscopy
11980Subcutaneous hormone pellet implantation (implantation of estradiol and/or testosterone pellets beneath the skin)
11981Insertion, drug delivery implant (i.e., bioresorbable, biodegradable, non-biodegradable)
11983Removal with reinsertion, non biodegradable drug delivery implant
45330Sigmoidoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)
45331Sigmoidoscopy, flexible; with biopsy, single or multiple
45332Sigmoidoscopy, flexible; with removal of foreign body(s)
45333Sigmoidoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps
45334Sigmoidoscopy, flexible; with control of bleeding, any method
45335Sigmoidoscopy, flexible; with directed submucosal injection(s), any substance
45338Sigmoidoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique
45346Sigmoidoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre and post dilation and guide wire passage, when performed)
45378Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)
45379Colonoscopy, flexible; with removal of foreign body(s)
45380Colonoscopy, flexible; with biopsy, single or multiple
45381Colonoscopy, flexible; with directed submucosal injection(s), any substance
45382Colonoscopy, flexible; with control of bleeding, any method
45384Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps
45385Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique
45388Colonoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre and post dilation and guide wire passage, when performed)
57170Diaphragm or cervical cap fitting with instructions
58300Insertion of intrauterine device (IUD)
58340Catheterization and introduction of saline or contrast material for saline infusion sonohysterography (SIS) or hysterosalpingography
58600Ligation or transection of fallopian tube(s), abdominal or vaginal approach, unilateral or bilateral
58605Ligation or transection of fallopian tube(s), abdominal or vaginal approach, postpartum, unilateral or bilateral, during same hospitalization (separate procedure)
58611Ligation 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)
58615Occlusion of fallopian tube(s) by device (eg, band, clip, Falope ring) vaginal or suprapubic approach
58671Laparoscopy, surgical; with occlusion of oviducts by device (eg, band, clip, or Falope ring)
59425Antepartum care only; 4 6 visits
59426Antepartum care only; 7 or more visits
59430Postpartum care only (separate procedure)
71271Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s)
74263Computed tomographic (CT) colonography, screening, including image postprocessing
76706Ultrasound, abdominal aorta, real time with image documentation, screening study for abdominal aortic aneurysm (AAA)
77065Diagnostic mammography, including computer aided detection (CAD) when performed; unilateral
77066Diagnostic mammography, including computer aided detection (CAD) when performed; bilateral
77067Screening mammography, bilateral (2 view study of each breast), including computer aided detection (CAD) when performed
77080Dual energy X ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine)
80050General health panel This panel must include the following: Comprehensive metabolic panel (80053) Blood count, complete (CBC), automated and automated differential WBC count (85025 or 85027 and 85004) OR Blood count, complete (CBC), automated (85027) and appropriate manual differential WBC count (85007 or 85009) Thyroid stimulating hormone (TSH) (84443)
80055Obstetric panel This panel must include the following: Blood count, complete (CBC), automated and automated differential WBC count (85025 or 85027 and 85004) OR Blood count, complete (CBC), automated (85027) and appropriate manual differential WBC count (85007 or 85009) Hepatitis B surface antigen (HBsAg) (87340) Antibody, rubella (86762) Syphilis test, non treponemal antibody; qualitative (eg, VDRL, RPR, ART) (86592) Antibody screen, RBC, each serum technique (86850) Blood typing, ABO (86900) AND Blood typing, Rh (D) (86901)
80061Lipid panel This panel must include the following: Cholesterol, serum, total (82465) Lipoprotein, direct measurement, high density cholesterol (HDL cholesterol) (83718) Triglycerides (84478)
80081Obstetric panel (includes HIV testing) This panel must include the following: Blood count, complete (CBC), and automated differential WBC count (85025 or 85027 and 85004) OR Blood count, complete (CBC), automated (85027) and appropriate manual differential WBC count (85007 or 85009) Hepatitis B surface antigen (HBsAg) (87340) HIV 1 antigen(s), with HIV 1 and HIV 2 antibodies, single result (87389) Antibody, rubella (86762) Syphilis test, non treponemal antibody; qualitative (eg, VDRL, RPR, ART) (86592) Antibody screen, RBC, each serum technique (86850) Blood typing, ABO (86900) AND Blood typing, Rh (D) (86901)
81000Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; non automated, with microscopy
81001Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; automated, with microscopy
81002Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; non automated, without microscopy
81003Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; automated, without microscopy
81025Urine pregnancy test, by visual color comparison methods
81162BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full sequence analysis and full duplication/deletion analysis (ie, detection of large gene rearrangements)
81163BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full sequence analysis
81164BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full duplication/deletion analysis (ie, detection of large gene rearrangements)
81165BRCA1 (BRCA1, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full sequence analysis
81166BRCA1 (BRCA1, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full duplication/deletion analysis (ie, detection of large gene rearrangements)
81167BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full duplication/deletion analysis (ie, detection of large gene rearrangements)
81212BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; 185delAG, 5385insC, 6174delT variants
81215BRCA1 (BRCA1, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; known familial variant
81216BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; full sequence analysis
81217BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; known familial variant
81528Oncology (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
82270Blood, 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)
82274Blood, occult, by fecal hemoglobin determination by immunoassay, qualitative, feces, 1 3 simultaneous determinations
82465Cholesterol, serum or whole blood, total
82565Creatinine; blood
82570Creatinine; other source
82575Creatinine; clearance
82947Glucose; quantitative, blood (except reagent strip)
82950Glucose; post glucose dose (includes glucose)
82951Glucose; tolerance test (GTT), 3 specimens (includes glucose)
82952Glucose; tolerance test, each additional beyond 3 specimens (List separately in addition to code for primary procedure)
83020Hemoglobin fractionation and quantitation; electrophoresis (eg, A2, S, C, and/or F)
83021Hemoglobin fractionation and quantitation; chromatography (eg, A2, S, C, and/or F)
83036Hemoglobin; glycosylated (A1C)
83655Lead
83718Lipoprotein, direct measurement; high density cholesterol (HDL cholesterol)
84030Phenylalanine (PKU), blood
84153Prostate specific antigen (PSA); total
84154Prostate specific antigen (PSA); free
84436Thyroxine; total
84437Thyroxine; requiring elution (eg, neonatal)
84439Thyroxine; free
84443Thyroid stimulating hormone (TSH)
84478Triglycerides
84703Gonadotropin, chorionic (hCG); qualitative
85013Blood count; spun microhematocrit
85014Blood count; hematocrit (Hct)
85018Blood count; hemoglobin (Hgb)
85025Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count
85027Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count)
86480Tuberculosis test, cell mediated immunity antigen response measurement; gamma interferon
86580Skin test; tuberculosis, intradermal
86592Syphilis test, non treponemal antibody; qualitative (eg, VDRL, RPR, ART)
86689Antibody; HTLV or HIV antibody, confirmatory test (eg, Western Blot)
86701Antibody; HIV 1
86702Antibody; HIV 2
86703Antibody; HIV 1 and HIV 2, single result
86780Antibody; Treponema pallidum
86803Hepatitis C antibody;
86901Blood typing, serologic; Rh (D)
87081Culture, presumptive, pathogenic organisms, screening only;
87084Culture, presumptive, pathogenic organisms, screening only; with colony estimation from density chart
87086Culture, bacterial; quantitative colony count, urine
87088Culture, bacterial; with isolation and presumptive identification of each isolate, urine
87270Infectious agent antigen detection by immunofluorescent technique; Chlamydia trachomatis
87320Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; Chlamydia trachomatis
87340Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; hepatitis B surface antigen (HBsAg)
87389Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; HIV-1 antigen(s), with HIV-1 and HIV-2 antibodies, single result
87390Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; HIV-1
87490Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, direct probe technique
87491Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, amplified probe technique
87521Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, amplified probe technique, includes reverse transcription when performed
87535Infectious agent detection by nucleic acid (DNA or RNA); HIV 1, amplified probe technique, includes reverse transcription when performed
87590Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae, direct probe technique
87591Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae, amplified probe technique
87592Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae, quantification
87623Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), low risk types (eg, 6, 11, 42, 43, 44)
87624Infectious 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)
87625Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), types 16 and 18 only, includes type 45, if performed
87800Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms; direct probe(s) technique
87801Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms; amplified probe(s) technique
87806Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; HIV-1 antigen(s), with HIV-1 and HIV-2 antibodies
87808Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; Trichomonas vaginalis
87810Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; Chlamydia trachomatis
87850Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; Neisseria gonorrhoeae
88141Cytopathology, cervical or vaginal (any reporting system), requiring interpretation by physician
88142Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; manual screening under physician supervision
88143Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; with manual screening and rescreening under physician supervision
88147Cytopathology smears, cervical or vaginal; screening by automated system under physician supervision
88148Cytopathology smears, cervical or vaginal; screening by automated system with manual rescreening under physician supervision
88150Cytopathology, slides, cervical or vaginal; manual screening under physician supervision
88152Cytopathology, slides, cervical or vaginal; with manual screening and computer assisted rescreening under physician supervision
88153Cytopathology, slides, cervical or vaginal; with manual screening and rescreening under physician supervision
88164Cytopathology, slides, cervical or vaginal (the Bethesda System); manual screening under physician supervision
88165Cytopathology, slides, cervical or vaginal (the Bethesda System); with manual screening and rescreening under physician supervision
88166Cytopathology, slides, cervical or vaginal (the Bethesda System); with manual screening and computer assisted rescreening under physician supervision
88167Cytopathology, slides, cervical or vaginal (the Bethesda System); with manual screening and computer assisted rescreening using cell selection and review under physician supervision
88174Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; screening by automated system, under physician supervision
88175Cytopathology, 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
88305Level IV Surgical pathology, gross and microscopic examination Abortion spontaneous/missed Artery, biopsy Bone marrow, biopsy Bone exostosis Brain/meninges, other than for tumor resection Breast, biopsy, not requiring microscopic evaluation of surgical margins Breast, reduction mammoplasty Bronchus, biopsy Cell block, any source Cervix, biopsy Colon, biopsy Duodenum, biopsy Endocervix, curettings/biopsy Endometrium, curettings/biopsy Esophagus, biopsy Extremity, amputation, traumatic Fallopian tube, biopsy Fallopian tube, ectopic pregnancy Femoral head, fracture Fingers/toes, amputation, non traumatic Gingiva/oral mucosa, biopsy Heart valve Joint, resection Kidney, biopsy Larynx, biopsy Leiomyoma(s), uterine myomectomy without uterus Lip, biopsy/wedge resection Lung, transbronchial biopsy Lymph node, biopsy Muscle, biopsy Nasal mucosa, biopsy Nasopharynx/oropharynx, biopsy Nerve, biopsy Odontogenic/dental cyst Omentum, biopsy Ovary with or without tube, non neoplastic Ovary, biopsy/wedge resection Parathyroid gland Peritoneum, biopsy Pituitary tumor Placenta, other than third trimester Pleura/pericardium biopsy/tissue Polyp, cervical/endometrial Polyp, colorectal Polyp, stomach/small intestine Prostate, needle biopsy Prostate, TUR Salivary gland, biopsy Sinus, paranasal biopsy Skin, other than cyst/tag/debridement/plastic repair Small intestine, biopsy Soft tissue, other than tumor/mass/lipoma/debridement Spleen Stomach, biopsy Synovium Testis, other than tumor/biopsy/castration Thyroglossal duct/brachial cleft cyst Tongue, biopsy Tonsil, biopsy Trachea, biopsy Ureter, biopsy Urethra, biopsy Urinary bladder, biopsy Uterus, with or without tubes and ovaries, for prolapse Vagina, biopsy Vulva/labia, biopsy
90380Respiratory syncytial virus, monoclonal antibody, seasonal dose; 0.5 mL dosage, for intramuscular use
90381Respiratory syncytial virus, monoclonal antibody, seasonal dose; 1 mL dosage, for intramuscular use
90396Varicella zoster immune globulin, human, for intramuscular use
90460Immunization 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
90461Immunization 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)
90471Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid)
90472Immunization 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)
90473Immunization administration by intranasal or oral route; 1 vaccine (single or combination vaccine/toxoid)
90474Immunization administration by intranasal or oral route; each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure)
90480Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, single dose
90587Dengue vaccine, quadrivalent, live, 3 dose schedule, for subcutaneous use
90619Meningococcal conjugate vaccine, serogroups A, C, W, Y, quadrivalent, tetanus toxoid carrier (MenACWY TT), for intramuscular use
90620Meningococcal recombinant protein and outer membrane vesicle vaccine, serogroup B (MenB 4C), 2 dose schedule, for intramuscular use
90621Meningococcal recombinant lipoprotein vaccine, serogroup B (MenB FHbp), 2 or 3 dose schedule, for intramuscular use
90623Meningococcal pentavalent vaccine, conjugated Men A, C, W, Y tetanus toxoid carrier, and Men B FHbp, for intramuscular use
90630Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, for intradermal use
90632Hepatitis A vaccine (HepA), adult dosage, for intramuscular use
90633Hepatitis A vaccine (HepA), pediatric/adolescent dosage 2 dose schedule, for intramuscular use
90636Hepatitis A and hepatitis B vaccine (HepA HepB), adult dosage, for intramuscular use
90647Haemophilus influenzae type b vaccine (Hib), PRP OMP conjugate, 3 dose schedule, for intramuscular use
90648Haemophilus influenzae type b vaccine (Hib), PRP T conjugate, 4 dose schedule, for intramuscular use
90649Human Papillomavirus vaccine, types 6, 11, 16, 18, quadrivalent (4vHPV), 3 dose schedule, for intramuscular use
90650Human Papillomavirus vaccine, types 16, 18, bivalent (2vHPV), 3 dose schedule, for intramuscular use
90651Human Papillomavirus vaccine types 6, 11, 16, 18, 31, 33, 45, 52, 58, nonavalent (9vHPV), 2 or 3 dose schedule, for intramuscular use
90653Influenza vaccine, inactivated (IIV), subunit, adjuvanted, for intramuscular use
90655Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL dosage, for intramuscular use
90656Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.5 mL dosage, for intramuscular use
90657Influenza virus vaccine, trivalent (IIV3), split virus, 0.25 mL dosage, for intramuscular use
90658Influenza virus vaccine, trivalent (IIV3), split virus, 0.5 mL dosage, for intramuscular use
90660Influenza virus vaccine, trivalent, live (LAIV3), for intranasal use
90661Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
90662Influenza virus vaccine (IIV), split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use
90670Pneumococcal conjugate vaccine, 13 valent (PCV13), for intramuscular use
90671Pneumococcal conjugate vaccine, 15 valent (PCV15), for intramuscular use
90672Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use
90673Influenza virus vaccine, trivalent (RIV3), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use
90674Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
90677Pneumococcal conjugate vaccine, 20 valent (PCV20), for intramuscular use
90678Respiratory syncytial virus vaccine, preF, subunit, bivalent, for intramuscular use
90679Respiratory syncytial virus vaccine, preF, recombinant, subunit, adjuvanted, for intramuscular use
90680Rotavirus vaccine, pentavalent (RV5), 3 dose schedule, live, for oral use
90681Rotavirus vaccine, human, attenuated (RV1), 2 dose schedule, live, for oral use
90682Influenza virus vaccine, quadrivalent (RIV4), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use
90683Respiratory syncytial virus vaccine, mRNA lipid nanoparticles, for intramuscular use
90684Pneumococcal conjugate vaccine, 21 valent (PCV21), for intramuscular use
90685Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.25 mL dosage, for intramuscular use
90686Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5 mL dosage, for intramuscular use
90687Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use
90688Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.5 mL dosage, for intramuscular use
90689Influenza virus vaccine, quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use
90694Influenza virus vaccine, quadrivalent (aIIV4), inactivated, adjuvanted, preservative free, 0.5 mL dosage, for intramuscular use
90696Diphtheria, tetanus toxoids, acellular pertussis vaccine and inactivated poliovirus vaccine (DTaP IPV), when administered to children 4 through 6 years of age, for intramuscular use
90697Diphtheria, tetanus toxoids, acellular pertussis vaccine, inactivated poliovirus vaccine, Haemophilus influenzae type b PRP OMP conjugate vaccine, and hepatitis B vaccine (DTaP IPV Hib HepB), for intramuscular use
90698Diphtheria, tetanus toxoids, acellular pertussis vaccine, Haemophilus influenzae type b, and inactivated poliovirus vaccine, (DTaP IPV/Hib), for intramuscular use
90700Diphtheria, tetanus toxoids, and acellular pertussis vaccine (DTaP), when administered to individuals younger than 7 years, for intramuscular use
90702Diphtheria and tetanus toxoids adsorbed (DT) when administered to individuals younger than 7 years, for intramuscular use
90707Measles, mumps and rubella virus vaccine (MMR), live, for subcutaneous use
90710Measles, mumps, rubella, and varicella vaccine (MMRV), live, for subcutaneous use
90713Poliovirus vaccine, inactivated (IPV), for subcutaneous or intramuscular use
90714Tetanus and diphtheria toxoids adsorbed (Td), preservative free, when administered to individuals 7 years or older, for intramuscular use
90715Tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap), when administered to individuals 7 years or older, for intramuscular use
90716Varicella virus vaccine (VAR), live, for subcutaneous use
90723Diphtheria, tetanus toxoids, acellular pertussis vaccine, hepatitis B, and inactivated poliovirus vaccine (DTaP HepB IPV), for intramuscular use
90732Pneumococcal polysaccharide vaccine, 23 valent (PPSV23), adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use
90733Meningococcal polysaccharide vaccine, serogroups A, C, Y, W 135, quadrivalent (MPSV4), for subcutaneous use
90734Meningococcal conjugate vaccine, serogroups A, C, W, Y, quadrivalent, diphtheria toxoid carrier (MenACWY D) or CRM197 carrier (MenACWY CRM), for intramuscular use
90739Hepatitis B vaccine (HepB), CpG-adjuvanted, adult dosage, 2 dose or 4 dose schedule, for intramuscular use
90740Hepatitis B vaccine (HepB), dialysis or immunosuppressed patient dosage, 3 dose schedule, for intramuscular use
90743Hepatitis B vaccine (HepB), adolescent, 2 dose schedule, for intramuscular use
90744Hepatitis B vaccine (HepB), pediatric/adolescent dosage, 3 dose schedule, for intramuscular use
90746Hepatitis B vaccine (HepB), adult dosage, 3 dose schedule, for intramuscular use
90747Hepatitis B vaccine (HepB), dialysis or immunosuppressed patient dosage, 4 dose schedule, for intramuscular use
90748Hepatitis B and Haemophilus influenzae type b vaccine (Hib HepB), for intramuscular use
90749Unlisted vaccine/toxoid
90750Zoster (shingles) vaccine (HZV), recombinant, subunit, adjuvanted, for intramuscular use
90756Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibiotic free, 0.5 mL dosage, for intramuscular use
90759Hepatitis B vaccine (HepB), 3-antigen (S, Pre-S1, Pre-S2), 10 mcg dosage, 3 dose schedule, for intramuscular use
91304Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, recombinant spike protein nanoparticle, saponin-based adjuvant, 5 mcg/0.5 mL dosage, for intramuscular use
91318Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, 3 mcg/0.2 mL dosage, tris-sucrose formulation, for intramuscular use
91319Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, 10 mcg/0.2 mL dosage, tris-sucrose formulation, for intramuscular use
91320Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, 30 mcg/0.3 mL dosage, tris-sucrose formulation, for intramuscular use
91321Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, 25 mcg/0.25 mL dosage, for intramuscular use
91322Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, 50 mcg/0.5 mL dosage, for intramuscular use
92551Screening test, pure tone, air only
92552Pure tone audiometry (threshold); air only
92579Visual reinforcement audiometry (VRA)
92582Conditioning play audiometry
92587Distortion 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
96040Medical genetics and genetic counseling services, each 30 minutes face to face with patient/family
96110Developmental screening (eg, developmental milestone survey, speech and language delay screen), with scoring and documentation, per standardized instrument
96127Brief emotional/behavioral assessment (eg, depression inventory, attention deficit/hyperactivity disorder [ADHD] scale), with scoring and documentation, per standardized instrument
96160Administration of patient focused health risk assessment instrument (eg, health hazard appraisal) with scoring and documentation, per standardized instrument
96161Administration of caregiver focused health risk assessment instrument (eg, depression inventory) for the benefit of the patient, with scoring and documentation, per standardized instrument
96372Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular
96380Administration of respiratory syncytial virus, monoclonal antibody, seasonal dose by intramuscular injection, with counseling by physician or other qualified health care professional
96381Administration of respiratory syncytial virus, monoclonal antibody, seasonal dose by intramuscular injection
97110Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility
97112Therapeutic 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
97116Therapeutic procedure, 1 or more areas, each 15 minutes; gait training (includes stair climbing)
97750Physical performance test or measurement (eg, musculoskeletal, functional capacity), with written report, each 15 minutes
97802Medical nutrition therapy; initial assessment and intervention, individual, face to face with the patient, each 15 minutes
97803Medical nutrition therapy; re assessment and intervention, individual, face to face with the patient, each 15 minutes
99153Moderate 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)
99173Screening test of visual acuity, quantitative, bilateral
99174Instrument based ocular screening (eg, photoscreening, automated refraction), bilateral; with remote analysis and report
99177Instrument based ocular screening (eg, photoscreening, automated refraction), bilateral; with on site analysis
99188Application of topical fluoride varnish by a physician or other qualified health care professional
99202Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 15-29 minutes of total time is spent on the date of the encounter.
99203Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 30-44 minutes of total time is spent on the date of the encounter.
99204Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using time for code selection, 45-59 minutes of total time is spent on the date of the encounter.
99205Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 60-74 minutes of total time is spent on the date of the encounter.
99211Office 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.
99212Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 10-19 minutes of total time is spent on the date of the encounter.
99213Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 20-29 minutes of total time is spent on the date of the encounter.
99214Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using time for code selection, 30-39 minutes of total time is spent on the date of the encounter.
99215Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter.
99381Initial 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)
99382Initial 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)
99383Initial 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)
99384Initial 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)
99385Initial 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
99386Initial 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
99387Initial 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
99391Periodic 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)
99392Periodic 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)
99393Periodic 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)
99394Periodic 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)
99395Periodic 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
99396Periodic 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
99397Periodic 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
99401Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15 minutes
99402Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 30 minutes
99403Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 45 minutes
99404Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 60 minutes
99406Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes
99407Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes
99408Alcohol and/or substance (other than tobacco) abuse structured screening (eg, AUDIT, DAST), and brief intervention (SBI) services; 15 to 30 minutes
99409Alcohol and/or substance (other than tobacco) abuse structured screening (eg, AUDIT, DAST), and brief intervention (SBI) services; greater than 30 minutes
99459Pelvic examination (List separately in addition to code for primary procedure)
99461Initial care, per day, for evaluation and management of normal newborn infant seen in other than hospital or birthing center
A4261Cervical cap for contraceptive use
A4267Contraceptive supply, condom, male, each
A4268Contraceptive supply, condom, female, each
A4269Contraceptive supply, spermicide (e.g., foam, gel), each
A4281Tubing for breast pump, replacement
A4282Adapter for breast pump, replacement
A4283Cap for breast pump bottle, replacement
A4284Breast shield and splash protector for use with breast pump, replacement
A4285Polycarbonate bottle for use with breast pump, replacement
A4286Locking ring for breast pump, replacement
A4287Disposable collection and storage bag for breast milk, any size, any type, each
E0602Breast pump, manual, any type
E0603Breast pump, electric (ac and/or dc), any type
G0008Administration of influenza virus vaccine
G0009Administration of pneumococcal vaccine
G0010Administration of hepatitis b vaccine
G0101Cervical or vaginal cancer screening; pelvic and clinical breast examination
G0102Prostate cancer screening; digital rectal examination
G0103Prostate cancer screening; prostate specific antigen test (psa)
G0104Colorectal cancer screening; flexible sigmoidoscopy
G0105Colorectal cancer screening; colonoscopy on individual at high risk
G0108Diabetes outpatient self management training services, individual, per 30 minutes
G0109Diabetes outpatient self management training services, group session (2 or more), per 30 minutes
G0121Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk
G0123Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, screening by cytotechnologist under physician supervision
G0124Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, requiring interpretation by physician
G0141Screening cytopathology smears, cervical or vaginal, performed by automated system, with manual rescreening, requiring interpretation by physician
G0143Screening 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
G0144Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, with screening by automated system, under physician supervision
G0145Screening 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
G0147Screening cytopathology smears, cervical or vaginal, performed by automated system under physician supervision
G0148Screening cytopathology smears, cervical or vaginal, performed by automated system with manual rescreening
G0159Services performed by a qualified physical therapist, in the home health setting, in the establishment or delivery of a safe and effective physical therapy maintenance program, each 15 minutes
G0270Medical 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
G0271Medical 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
G0306Complete cbc, automated (hgb, hct, rbc, wbc, without platelet count) and automated wbc differential count
G0307Complete (cbc), automated (hgb, hct, rbc, wbc; without platelet count)
G0328Colorectal cancer screening; fecal occult blood test, immunoassay, 1 3 simultaneous
G0432Infectious agent antibody detection by enzyme immunoassay (eia) technique, hiv 1 and/or hiv 2, screening
G0433Infectious agent antibody detection by enzyme linked immunosorbent assay (elisa) technique, hiv 1 and/or hiv 2, screening
G0435Infectious agent antibody detection by rapid antibody test, hiv 1 and/or hiv 2, screening
G0438Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit
G0439Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit
G0444Annual depression screening, 5 to 15 minutes
G0445High intensity behavioral counseling to prevent sexually transmitted infection; face to face, individual, includes: education, skills training and guidance on how to change sexual behavior; performed semi annually, 30 minutes
G0447Face to face behavioral counseling for obesity, 15 minutes
G0451Development testing, with interpretation and report, per standardized instrument form
G0472Hepatitis c antibody screening, for individual at high risk and other covered indication(s)
G0473Face to face behavioral counseling for obesity, group (2 10), 30 minutes
G0476Infectious agent detection by nucleic acid (dna or rna); human papillomavirus (hpv), high risk types (e.g., 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68) for cervical cancer screening, must be performed in addition to pap test
G0499Hepatitis b screening in non pregnant, high risk individual includes hepatitis b surface antigen (hbsag), antibodies to hbsag (anti hbs) and antibodies to hepatitis b core antigen (anti hbc), and is followed by a neutralizing confirmatory test, when performed, only for an initially reactive hbsag result
G0500Moderate 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)
J0750Emtricitabine 200mg and tenofovir disoproxil fumarate 300mg, oral, fda approved prescription, only for use as hiv pre-exposure prophylaxis (not for use as treatment of hiv)
J0751Emtricitabine 200mg and tenofovir alafenamide 25mg, oral, fda approved prescription, only for use as hiv pre-exposure prophylaxis (not for use as treatment of hiv)
J0799FDA approved prescription drug, only for use as hiv pre-exposure prophylaxis (not for use as treatment of hiv), not otherwise classified
J1050Injection, medroxyprogesterone acetate, 1 mg
J7294Segesterone acetate and ethinyl estradiol 0.15mg, 0.013mg per 24 hours; yearly vaginal system, each
J7295Ethinyl estradiol and etonogestrel 0.015mg, 0.12mg per 24 hours; monthly vaginal ring, each
J7296Levonorgestrel releasing intrauterine contraceptive system, (kyleena), 19.5 mg
J7297Levonorgestrel releasing intrauterine contraceptive system (liletta), 52 mg
J7298Levonorgestrel releasing intrauterine contraceptive system (mirena), 52 mg
J7300Intrauterine copper contraceptive
J7301Levonorgestrel releasing intrauterine contraceptive system (skyla), 13.5 mg
J7303Contraceptive supply, hormone containing vaginal ring, each
J7304Contraceptive supply, hormone containing patch, each
J7306Levonorgestrel (contraceptive) implant system, including implants and supplies
J7307Etonogestrel (contraceptive) implant system, including implant and supplies
P3000Screening papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision
P3001Screening papanicolaou smear, cervical or vaginal, up to three smears, requiring interpretation by physician
Q0091Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory
Q0516Pharmacy supplying fee for hiv pre-exposure prophylaxis FDA approved prescription drug, per 30-days
Q0517Pharmacy supplying fee for hiv pre-exposure prophylaxis FDA approved prescription drug, per 60-days
Q0518Pharmacy supplying fee for hiv pre-exposure prophylaxis FDA approved prescription drug, per 90-days
Q0519Pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription injectable drug, per 30-days
Q0520Pharmacy supplying fee for hiv pre-exposure prophylaxis fda approved prescription injectable drug, per 60-days
S0156Exemestane, 25 mg
S0170Anastrozole, oral, 1 mg
S0187Tamoxifen citrate, oral, 10 mg
S0265Genetic counseling, under physician supervision, each 15 minutes
S0610Annual gynecological examination, new patient
S0612Annual gynecological examination, established patient
S3620Newborn 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; phenylalanine (pku); and thyroxine, total)
S3645Hiv 1 antibody testing of oral mucosal transudate
S4981Insertion of levonorgestrel releasing intrauterine system
S4989Contraceptive intrauterine device (e.g., progestacert iud), including implants and supplies
S4993Contraceptive pills for birth control
S9131Physical therapy; in the home, per diem
S9140Diabetic management program, follow up visit to non md provider
S9141Diabetic management program, follow up visit to md provider
S9452Nutrition classes, non physician provider, per session
S9455Diabetic management program, group session
S9460Diabetic management program, nurse visit
S9465Diabetic management program, dietitian visit
S9470Nutritional counseling, dietitian visit
Group specific policy will supersede this policy when applicable. This policy does not apply to the Wal-Mart Associates Group Health Plan participants or to the Tyson Group Health Plan participants.
CPT Codes Copyright © 2024 American Medical Association.