Coverage Policy Manual
Policy #: 2012021
Category: PPACA Preventive
Initiated: May 2012
Last Review: June 2022
  PREVENTIVE SERVICES FOR NON-GRANDFATHERED (PPACA) PLANS: INTIMATE PARTNER VIOLENCE; SCREENING IN WOMEN

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.
 

Policy/
Coverage:
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.   
 

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.
 
 

CPT/HCPCS:
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
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

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.

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.


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.
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