| Coverage Policy Manual | |
| Policy #: | 2012021 |
| Category: | PPACA Preventive |
| Initiated: | May 2012 |
| Last Review: | June 2023 |
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| PREVENTIVE SERVICES FOR NON-GRANDFATHERED (PPACA) PLANS: INTIMATE PARTNER, INTERPERSONAL, AND DOMESTIC VIOLENCE; SCREENING IN WOMEN AND ADOLESCENTS | |
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| Description: |
The Federal Patient Protection and Preventive Care Act 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. Preventive services that have strong scientific evidence of their health benefits must be covered and plans can no longer charge a patient a copayment, coinsurance or deductible for these services when they are delivered by a network provider. A component of the law was a requirement that all “non-grandfathered” health insurance plans are required to provide coverage without cost sharing consistent with the Health Resources and Services Administration ‘s (HRSA’s) Women's Preventive Services: Required Health Plan Coverage Guidelines.
The HRSA-supported health plan coverage guidelines were developed by the Department of Health and Human Services (HHS) commissioned Institute of Medicine (IOM). HHS commissioned an IOM study to review what preventive services are necessary for women’s health and well-being and should be considered in the development of comprehensive guidelines for preventive services for women. HRSA supports the IOM’s recommendations on preventive services that address health needs specific to women and fill gaps in existing guidelines.
Non-grandfathered plans and issuers are required to provide coverage without cost sharing consistent with these guidelines starting August 1, 2012.
Plans are not required to provide coverage for the preventive services if they are delivered by out-of-network providers.
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Policy/ Coverage: |
Effective July 2023
Screening/counseling of women and adolescents for intimate partner, interpersonal, and domestic violence is covered annually for members of “non-grandfathered” plans, without cost-sharing (i.e., deductible, co-insurance, or co-pay).
The appropriate ICD-10 codes to report these services are Z69.11, Z00.00-Z00.01, Z00.121, Z00.129.
Codes that may be used to report this service include CPT 99384, 99385, 99386, 99387, 99394, 99395, 99396, 99397 or 99401-99404.
Effective prior to July 2023
Screening/counseling of women for intimate partner violence is covered annually for members of “non-grandfathered” plans, without cost-sharing (i.e., deductible, co-insurance, or co-pay).
The appropriate ICD-10 codes to report these services are Z69.11, Z00.00-Z00.01.
Codes that may be used to report this service include CPT 99385, 99386, 99387, 99395, 99396, 99397 or 99401-99404.
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| Rationale: |
A systematic review updating the 2004 USPSTF Recommendation on screening women for intimate partner violence was published (Nelson, 2012). Intimate partner violence (IPV) includes a wide range of abusive behaviors by someone who is or was involved in an intimate relationship with the victim. Intimate partner violence can occur in both men and women but more women experience IPV than men.
The National Advisory Council on Violence and Abuse, the American Congress of Obstetricians and Gynecologists and the Committee on Child Abuse and Neglect all support screening for IPV.
The authors of the systematic review (Nelson, 2012) concluded that screening women for IPV could reduce IPV and improve health outcomes depending on the population screened and outcome measured.
2023 Update
The current HRSA guidelines for screening and counseling for interpersonal and domestic violence states: WPSI recommends screening adolescents and women for interpersonal and domestic violence, at least annually, and, when needed, providing, or referring for initial intervention services. Interpersonal and domestic violence includes physical violence, sexual violence, stalking and psychological aggression (including coercion), reproductive coercion, neglect, and the threat of violence, abuse, or both. Intervention services include, but are not limited to, counseling, education, harm reduction strategies, and referral to appropriate supportive services.
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| References: |
American Congress of Obstetricians and Gynecologists. Screening Tools-Domestic Violence. American College of Obstetricians and Gynecologists; 2012. Accessed at www.acog.org/About_ACOG/ACOG_Departments/Violence_Against_Women/Screening_Tools_Domestic_Violence. Health Resources & Services Administration (HRSA).(2023) Women’s Preventive Services Guidelines. Accessed 6/15/2023. https://www.hrsa.gov/womens-guidelines. IOM (Institute of Medicine).(2011) Clinical Preventive Services for Women: Closing the Gaps. Washington, DC: The National Acadamies Press. National Advisory Council on Violence and Abuse. Policy Compendium. American Medical Association; 2008. Accessed at www.ama-assn.org/ama1/pub/upload/mm/386/vio_policy_comp.pdf. Nelson HD, Bougatsos C., and Blazina I.(2012) Screening women for intimate partner violence. A systematic review to update the 2004 U.S. Preventive Services Task Force Recommendation. Ann Intern Med. 2012; 156 (11). Thackeray JD, Hibbard R, Dowd MD.(2010) Committee on Child Abuse and Neglect. Intimate partner violence: the role of the pediatrician. Pediatrics. 2010; 125:1094-100. |
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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. |
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