Notification



Notification Issue Date:



Policy Attachment


Attachment to Policy # 00.06.02ab


Attachment:A

Policy #:00.06.02ab

Description:Adult Preventive Services

Title:Preventive Care Services (Independence)


Inclusion of a code in this table does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.

The codes listed below are updated on a regular basis, in accordance with nationally accepted coding guidelines. Therefore, this policy applies to any and all future applicable coding changes, revisions, or updates.

In order to ensure optimal reimbursement, all health care services, devices, and pharmaceuticals should be reported using the billing codes and modifiers that most accurately represent the services rendered, unless otherwise directed by the Company.



The intent of this attachment is to communicate services that may be considered adults' preventive services for individuals or groups for whom these services apply.

ADULT PREVENTIVE CARE SERVICES
  • Visits
    • Preventive Exams
  • Screenings
    • Abdominal Aortic Aneurysm (AAA) Screening
    • Abnormal Blood Glucose and Type 2 Diabetes Mellitus Screening and Intensive Behavioral Counseling Interventions
    • Colorectal Cancer Screening
      • Services Performed in Connection with a preventive colorectal cancer screening procedure
    • Depression Screening
    • Hepatitis B Virus Screening
    • Hepatitis C Virus Screening
    • High Blood Pressure Screening
    • Human Immunodeficiency Virus (HIV) Screening
    • Latent Tuberculosis Infection Screening
    • Lipid Disorder Screening
    • Lung Cancer Screening
    • Syphilis Screening
    • Unhealthy Alcohol Use Screening and Behavioral Counseling Interventions
  • Therapy and Counseling
    • Services Included as Part of the Comprehensive Preventive Exam
      • Behavioral Counseling for Skin Cancer Prevention
      • High Blood Pressure Screening (Office-based)
      • Obesity Screening
    • Behavioral Counseling for Prevention of Sexually Transmitted Infections
    • Behavioral Interventions for Weight Loss
    • Exercise Interventions for the Prevention of Falls
    • Intensive Behavioral Counseling to Promote a Healthful Diet and Physical Activities for Cardiovascular Disease Prevention
    • Nutritional Counseling for Weight Management
    • Tobacco Use Counseling
  • Medications
    • Low dose Aspirin
    • Prescription Bowel Preparation Medication
    • Statins for the Primary Prevention of Cardiovascular Disease
    • Tobacco Cessation medication
  • Miscellaneous
    • Immunizations
    • Prolonged Preventive Services

Appropriate gender-specific recommended preventive services are covered as a preventive service for transgender individuals as determined by the individual's healthcare provider.

VISITS

PREVENTIVE EXAMS
Preventive exams are covered as a preventive service for all adults, 1 preventive exam every year.

CPT Procedure Code Number(s) and Narrative(s) 99385, 99386, 99387, 99395, 99396, 99397
ICD-10 Diagnosis Code Number(s) and Narrative(s) N/A
HCPCS Level II Code Number(s) and Narrative(s) G0438 Annual Wellness Visit; includes a personalized prevention plan of service (PPS) Initial Visit

G0439 Annual Wellness Visit; includes a personalized prevention plan of service (PPS) Subsequent Visit

SCREENINGS

ABDOMINAL AORTIC ANEURYSM (AAA) SCREENING
Abdominal aortic aneurysm (AAA) screening is covered as a preventive service for asymptomatic males ages 65 to 75 years with a history of smoking. The frequency for this preventive service is once in a lifetime.

CPT Procedure Code Number(s) and Narrative(s) 76706
ICD-10 Diagnosis Code Number(s) and Narrative(s) FOR ABDOMINAL AORTIC ANEURYSM SCREENING, HCPCS CODE G0389 IS COVERED AS PREVENTIVE FOR THE FOLLOWING DIAGNOSIS CODES:

F17.210 Nicotine dependence, cigarettes, uncomplicated

F17.211 Nicotine dependence, cigarettes, in remission

F17.213 Nicotine dependence, cigarettes, with withdrawal

F17.218 Nicotine dependence, cigarettes, with other nicotine-induced disorders

F17.219 Nicotine dependence, cigarettes, with unspecified nicotine-induced disorders

Z72.0 Tobacco use

Z87.891 Personal history of nicotine dependence
HCPCS Level II Code Number(s) and Narrative(s) N/A

ABNORMAL BLOOD GLUCOSE AND TYPE 2 DIABETES MELLITUS SCREENING AND INTENSIVE BEHAVIORAL COUNSELING INTERVENTIONS
Abnormal blood glucose and type 2 diabetes mellitus screening is covered as a preventive service as part of a cardiovascular risk assessment in adults 40 to 70 years who are overweight or obese. Intensive behavioral counseling interventions for abnormal blood glucose to promote a healthful diet and physical activity are covered as a preventive service for individuals 40 to 70 years who are overweight or obese with abnormal blood glucose for up to 24 sessions a year.

CPT Procedure Code Number(s) and Narrative(s) 0403T, 82947, 82950, 82951, 82952, 83036

WHEN THE FOLLOWING CODES ARE REPORTED IN CONJUNCTION WITH TYPE 2 DIABETES MELLITUS SCREENING, THEY ARE COVERED AS A PREVENTIVE SERVICE:

36415, 36416, 99000
ICD-10 Diagnosis Code Number(s) and Narrative(s) FOR TYPE 2 DIABETES MELLITUS SCREENING, HCPCS CODES 82947, 82950, 82951, 82952, AND 83036 ARE COVERED AS PREVENTIVE WITH THE FOLLOWING DIAGNOSIS CODE:

Z13.1 Encounter for screening for diabetes mellitus

FOR INTENSIVE BEHAVIORAL COUNSELING INTERVENTIONS FOR ABNORMAL BLOOD GLUCOSE, CPT CODE 0403T IS COVERED AS PREVENTIVE WITH THE FOLLOWING DIAGNOSIS CODE:

R73.03 Prediabetes

R73.09 Other abnormal glucose
HCPCS Level II Code Number(s) and Narrative(s) N/A

COLORECTAL CANCER SCREENING
Colorectal cancer screening is covered as a preventive service for an individual 50 years or older.

Colorectal cancer screening includes any of the following tests:
  • Fecal occult blood testing (1 every year)
  • Highly sensitive fecal immunochemical testing (FIT) - (1 every year)
  • Flexible sigmoidoscopy (1 every 5 years)
  • CT colonography - (1 every 5 years)
  • Stool DNA testing alone or combined with FIT- (1 every 3 years)
  • Colonoscopy - (1 every 10 years)

* For colorectal cancer screening services and schedules other than indicated above, there may be a requirement of an appropriate cost-sharing when medical necessity criteria are met. Please refer to the 11.03.12 colorectal cancer screening medical policy for more information.

Pre-procedure consultation for a colorectal cancer screening procedure is covered as a preventive service for individuals who are eligible for coverage of a colorectal cancer screening procedure when the attending provider determines that the pre-procedure consultation will be medically appropriate.

During the pre-procedure consultation, the healthcare provider examines the individual to determine if the individual is healthy enough for the procedure and explains the process to the individual, including the required preparation for the procedure, all of which are necessary to protect the health of the individual. It is not expected that this service would be reported on the same date as the screening procedure.

CPT Procedure Code Number(s) and Narrative(s)
THE FOLLOWING CODE REPRESENTS FECAL OCCULT BLOOD TESTING:

82270

THE FOLLOWING CODES REPRESENT FLEXIBLE SIGMOIDOSCOPY:
The following codes will only be considered preventive when a screening flexible sigmoidoscopy meets all of the preventive criteria and is reported with modifier PT , modifier 33, or ICD-10 diagnosis code Z12.11 or Z12.12.

45330, 45331, 45333, 45338, 45346, 45349

THE FOLLOWING CODES REPRESENT CT COLONOGRAPHY:

74263

THE FOLLOWING CODES REPRESENT STOOL DNA TESTING:

81528

THE FOLLOWING CODES REPRESENT COLONOSCOPY:
The following codes will only be considered preventive when a screening colonoscopy meets all of the preventive criteria and is reported with modifier PT , modifier 33, or ICD-10 diagnosis code Z12.11 or Z12.12.

44388, 44389, 44392, 44394, 44401, 44403, 44406, 44407, 45378, 45380, 45381, 45384, 45385, 45388, 45390

THE FOLLOWING CODE REPRESENTS ANESTHESIA FOR LOWER INTESTINAL ENDOSCOPIC PROCEDURES. IT IS CONSIDERED PREVENTIVE WHEN REPORTED IN CONJUNCTION WITH A PREVENTIVE COLONOSCOPY OR SIGMOIDOSCOPY:

00811, 00812, 00813

THE FOLLOWING CODES MAY BE USED TO REPRESENT PRE-PROCEDURE CONSULTATIONS FOR SCREENING FLEXIBLE SIGMOIDOSCOPY OR CT COLONOGRAPHY WHEN REPORTED WITH ICD-10 DIAGNOSIS CODES Z12.11 OR Z12.12:

99201, 99202, 99203, 99211, 99212, 99213, 99241, 99242, 99243

ICD-10 Diagnosis Code Number(s) and Narrative(s) Z12.11 Encounter for screening for malignant neoplasm of colon

Z12.12 Encounter for screening for malignant neoplasm of rectum
HCPCS Level II Code Number(s) and Narrative(s)THE FOLLOWING CODE REPRESENTS HIGHLY SENSITIVE FECAL IMMUNOCHEMICAL TESTING:

G0328 Colorectal cancer screening; fecal-occult blood test, immunoassay, 1-3 simultaneous determinations.

THE FOLLOWING CODE REPRESENTS FLEXIBLE SIGMOIDOSCOPY:

G0104 Colorectal cancer screening; flexible sigmoidoscopy

THE FOLLOWING CODES REPRESENT COLONOSCOPY:

G0105 Colorectal cancer screening; colonoscopy on individual at high risk

G0121 Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk

THE FOLLOWING CODE REPRESENTS PRE-PROCEDURE CONSULTATION FOR SCREENING COLONOSCOPY:

S0285 Colonoscopy consultation performed prior to a screening colonoscopy procedure
Modifier(s) and Narrative(s)PT Colorectal cancer screening test, converted to diagnostic test or other procedure

33 Preventive Services

Services performed in connection with a preventive colorectal cancer screening procedure
The services listed below when performed in connection with a colorectal cancer screening will be considered preventive when billed with preventive colonoscopy or flexible sigmoidoscopy.

* Other non-preventive services (e.g. EGD) even when performed during the same session as a colorectal cancer screening procedure are not considered preventive.

CPT Procedure Code Number(s) and Narrative(s)
85014, 85018, 85025, 85027, 88104, 88108, 88112, 88160, 88161, 88162, 88302, 88304, 88305, 94760, 96360, 96365, 96366, 96372, 99100, 99140, 99152, 99153, 99156, 99157
ICD-10 Diagnosis Code Number(s) and Narrative(s) N/A
HCPCS Level II Code Number(s) and Narrative(s) A4246 Betadine or Phisohex solution, per pint

C9285 Lidocaine 70 mg/Tetracaine 70 mg, per patch

G0500 Moderate sedation services provided by the same physician or other qualified health care professional performing a gastrointestinal endoscopic service that sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient's level of consciousness and physiological status; initial 15 minutes of intra-service time; patient age 5 years or older (additional time may be reported with 99153, as appropriate)

J0131 Injection, Acetaminophen, 10 mg

J0171 Injection, Adrenalin, Epinephrine, 0.1 mg

J0290 Injection, Ampicillin Sodium, 500 mg

J0295 Injection, Ampicillin Sodium/Sulbactam Sodium, per 1.5 gram

J0461 Injection, Atropine Sulfate, 0.01 mg

J0670 Injection, Mepivacaine HCL, per 10 mL

J0690 Injection, Cefazolin Sodium, 500 mg

J0692 Injection, Cefepime Hydrochloride, 500 mg

J0694 Injection, Cefoxitin Sodium, 1 Gm

J0696 Injection, Ceftriaxone Sodium, per 250 mg

J0744 Injection, Ciprofloxacin for intravenous infusion, 200 mg

J0780 Injection, Prochlorperazine, up to 10 mg

J1170 Injection, Hydromorphone, up to 4 mg

J1200 Injection, Diphenhydramine HCL, up to 50 mg

J1260 Injection, Dolasetron Mesylate, 10 mg

J1335 Injection, Ertapenem Sodium, 500 mg

J1580 Injection, Garamycin, Gentamicin, up to 80 mg

J1626 Injection, Granisetron Hydrochloride, 100 mcg

J1741 Injection, Ibuprofen, 100 mg

J1790 Injection, Droperidol, up to 5 mg

J1810 Injection, Droperidol and Fentanyl Citrate, up to 2 ml ampule

J1885 Injection, Ketorolac Tromethamine, per 15 mg

J1956 Injection, Levofloxacin, 250 mg

J2001 Injection, Lidocaine HCl for intravaenous infusion, 10 mg

J2010 Injection, Lincomycin HCl, up to 300 mg

J2060 Injection, Lorazepam, 2 mg

J2175 Injection, Merperidine Hydrochloride, per 100 mg

J2180 Injection, Merperidine and Promethazine HCl, up to 50 mg

J2250 Injection, Midazolam Hydrochloride, per 1 mg

J2270 Injection, Morphine Sulfate, up to 10 mg

J2271 Injection, Morphine sulfate, 100 mg

J2275 Injection, Morphine Sulfate (preservative-free solution), per 10 mg

J2300 Injection, Nalbuphine HCL, per 10 mg

J2310 Injection, Naloxone Hydrochloride, per 1 mg

J2400 Injection, Chloroprocaine HCL, per 30 mL

J2405 Injection, Ondansetron Hydrochloride, per 1 mg

J2469 Injection, Palonosetron HCl, up to 25 mcg

J2543 Injection, Piperacillin Sodium/Tazobactam Sodium, 1 Gram /0.125 Grams (1.125 Grams)

J2550 Injection, Promethazine HCl, up to 50mg

J2704 Injection, Propofol, 10 mg

J2710 Injection, Neostigmine Methysulfate, up to 0.5 mg

J2765 Injection, Metochlopramide HCl, up to 10 mg

J2780 Injection, Ranitidine HCL, 25 mg

J2795 Injection, Ropivacaine HCL, 1 mg

J2805 Injection, Sincalide, 5 micrograms

J3010 Injection, Fentanyl Citrate, 0.1 mg

J3260 Injection, Tobramycin sulfate, up to 80 mg

J3360 Injection, Diazepam, up to 5 mg

J3370 Injection, Vancomycin HCl, 500 mg

J3410 Injection, Hydroxyzine HCl, up to 25 mg

J3475 Injection, Magnesium Sulfate, per 500 mg

J7040 Infusion, Normal Saline Solution, 500 cc

J7050 Infusion, Normal Saline Solution, 250 cc

J7120 Ringers Lactate Infusion, up to 1000 cc

J8501 Aprepitant, oral, 5 mg

Q0144 Azithromycin dihydrate, oral, capsules/powder, 1 gm

S0020 Injection, Bupivicaine HCL, 30 mL

S0028 Injection, Famotidine, 20 mg

S0030 Injection, Metronidazole, 500 mg

S0073 Injection, Aztreonam, 500 mg

S0074 Injection, Cefotetan Disodium, 500 mg

S0077 Injection, Clindamycin Phosphate, 300 mg

S0119 Ondasetron,oral, 4 mg (for circumstances falling under the Medicare statute, use HCPCS Q code)

S0164 Injection, Pantoprazole sodium, 40 mg

S5010 5% Dextrose and 0.45% Normal Saline, 1000 ml
Revenue Code Number(s) and Narrative(s)0250 Pharmacy - general classification

0251 Pharmacy - generic drugs

0258 Pharmacy - IV solutions

0260 IV therapy - general classification

0261 IV therapy - infusion pump

0263 IV therapy – therapy/drug/supply delivery

0270 Medical/surgical supplies and devices - general classification

0271 Medical/surgical supplies and devices-non sterile supply

0272 Medical/surgical supplies and devices-sterile supply

0310 Laboratory pathological-general classification

0314 Laboratory pathological-biopsy

0370 Anesthesia - general classification

0710 Recovery room-general classification

0963 Professional fees-anesthesiologist (MD)

0964 Professional fees - Anesthetist (CRNA)

0983 Professional fees - clinic


DEPRESSION SCREENING
Annual depression screening is covered as a preventive service for all adults when adequate measures are in place to ensure accurate diagnosis, effective treatment, and follow-up to reduce the symptoms of depression.

CPT Procedure Code Number(s) and Narrative(s) 96127
ICD-10 Diagnosis Code Number(s) and Narrative(s) FOR DEPRESSION SCREENING, CPT CODE 96127 WILL ONLY BE COVERED AS A PREVENTIVE SERVICE FOR THE FOLLOWING DIAGNOSIS CODE:

Z13.31 Encounter for screening for depression
HCPCS Level II Code Number(s) and Narrative(s) G0444 Annual depression screening, 15 minutes

HEPATITIS B VIRUS SCREENING
Hepatitis B virus screening is covered as a preventive service for all asymptomatic adults at high risk for HBV infection
High Risk Hepatitis B virus screening is defined by any of the following:

  • Foreign-born individuals whose country of origin has a high prevalence of Hepatitis B (2 percent or greater)
  • Individuals with a lack of vaccination in infancy in US-born infants with parents from high prevalence areas (8 percent or greater)
  • Individuals who are HIV positive
  • Individuals who are Injection drug users
  • Individuals who have contact with Hepatitis B infected individuals
  • Males who have sex with other males
  • Individuals who are receiving hemodialysis or cytotoxic treatment or immunosuppressive treatment
CPT Procedure Code Number(s) and Narrative(s)
86704, 86705, 86706, 87340, 87341

WHEN THE FOLLOWING CODES ARE REPORTED IN CONJUNCTION WITH HEPATITIS B VIRUS SCREENING, THEY ARE COVERED AS A PREVENTIVE SERVICE:

36415, 36416, 99000
ICD-10 Diagnosis Code Number(s) and Narrative(s) FOR HEPATITIS B VIRUS SCREENING, CPT CODES 86704, 86705, 86706, 87340, 87341 AND HCPCS CODE G0499 WILL ONLY BE COVERED AS A PREVENTIVE SERVICE FOR THE FOLLOWING DIAGNOSIS CODE:

B20 Human immunodeficiency virus [HIV] disease

F11.10 Opioid abuse, uncomplicated

F11.120 Opioid abuse with intoxication, uncomplicated

F11.121 Opioid abuse with intoxication delirium

F11.122 Opioid abuse with intoxication with perceptual disturbance

F11.129 Opioid abuse with intoxication, unspecified

F11.14 Opioid abuse with opioid-induced mood disorder

F11.150 Opioid abuse with opioid-induced psychotic disorder with delusions

F11.151 Opioid abuse with opioid-induced psychotic disorder with hallucinations

F11.159 Opioid abuse with opioid-induced psychotic disorder, unspecified

F11.181 Opioid abuse with opioid-induced sexual dysfunction

F11.182 Opioid abuse with opioid-induced sleep disorder

F11.188 Opioid abuse with other opioid-induced disorder

F11.19 Opioid abuse with unspecified opioid-induced disorder

F11.20 Opioid dependence, uncomplicated

F11.220 Opioid dependence with intoxication, uncomplicated

F11.221 Opioid dependence with intoxication delirium

F11.222 Opioid dependence with intoxication with perceptual disturbance

F11.229 Opioid dependence with intoxication, unspecified

F11.23 Opioid dependence with withdrawal

F11.24 Opioid dependence with opioid-induced mood disorder

F11.250 Opioid dependence with opioid-induced psychotic disorder with delusions

F11.251 Opioid dependence with opioid-induced psychotic disorder with hallucinations

F11.259 Opioid dependence with opioid-induced psychotic disorder, unspecified

F11.281 Opioid dependence with opioid-induced sexual dysfunction

F11.282 Opioid dependence with opioid-induced sleep disorder

F11.288 Opioid dependence with other opioid-induced disorder

F11.29 Opioid dependence with unspecified opioid-induced disorder

F11.90 Opioid use, unspecified, uncomplicated

F11.920 Opioid use, unspecified with intoxication, uncomplicated

F11.921 Opioid use, unspecified with intoxication delirium

F11.922 Opioid use, unspecified with intoxication with perceptual disturbance

F11.929 Opioid use, unspecified with intoxication, unspecified

F11.93 Opioid use, unspecified with withdrawal

F11.94 Opioid use, unspecified with opioid-induced mood disorder

F11.950 Opioid use, unspecified with opioid-induced psychotic disorder with delusions

F11.951 Opioid use, unspecified with opioid-induced psychotic disorder with hallucinations

F11.959 Opioid use, unspecified with opioid-induced psychotic disorder, unspecified

F11.981 Opioid use, unspecified with opioid-induced sexual dysfunction

F11.982 Opioid use, unspecified with opioid-induced sleep disorder

F11.988 Opioid use, unspecified with other opioid-induced disorder

F11.99 Opioid use, unspecified with unspecified opioid-induced disorder

F13.10 Sedative, hypnotic or anxiolytic abuse, uncomplicated

F13.120 Sedative, hypnotic or anxiolytic abuse with intoxication, uncomplicated

F13.121 Sedative, hypnotic or anxiolytic abuse with intoxication delirium

F13.129 Sedative, hypnotic or anxiolytic abuse with intoxication, unspecified

F13.14 Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced mood disorder

F13.150 Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced psychotic disorder with delusions

F13.151 Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced psychotic disorder with hallucinations

F13.159 Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced psychotic disorder, unspecified

F13.180 Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced anxiety disorder

F13.181 Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced sexual dysfunction

F13.182 Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced sleep disorder

F13.188 Sedative, hypnotic or anxiolytic abuse with other sedative, hypnotic or anxiolytic-induced disorder

F13.19 Sedative, hypnotic or anxiolytic abuse with unspecified sedative, hypnotic or anxiolytic-induced disorder

F13.20 Sedative, hypnotic or anxiolytic dependence, uncomplicated

F13.220 Sedative, hypnotic or anxiolytic dependence with intoxication, uncomplicated

F13.221 Sedative, hypnotic or anxiolytic dependence with intoxication delirium

F13.229 Sedative, hypnotic or anxiolytic dependence with intoxication, unspecified

F13.230 Sedative, hypnotic or anxiolytic dependence with withdrawal, uncomplicated

F13.231 Sedative, hypnotic or anxiolytic dependence with withdrawal delirium

F13.232 Sedative, hypnotic or anxiolytic dependence with withdrawal with perceptual disturbance

F13.239 Sedative, hypnotic or anxiolytic dependence with withdrawal, unspecified

F13.24 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced mood disorder

F13.250 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced psychotic disorder with delusions

F13.251 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced psychotic disorder with hallucinations

F13.259 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced psychotic disorder, unspecified

F13.26 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced persisting amnestic disorder

F13.27 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced persisting dementia

F13.280 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced anxiety disorder

F13.281 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced sexual dysfunction

F13.282 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced sleep disorder

F13.288 Sedative, hypnotic or anxiolytic dependence with other sedative, hypnotic or anxiolytic-induced disorder

F13.29 Sedative, hypnotic or anxiolytic dependence with unspecified sedative, hypnotic or anxiolytic-induced disorder

F13.90 Sedative, hypnotic, or anxiolytic use, unspecified, uncomplicated

F13.920 Sedative, hypnotic or anxiolytic use, unspecified with intoxication, uncomplicated

F13.921 Sedative, hypnotic or anxiolytic use, unspecified with intoxication delirium

F13.929 Sedative, hypnotic or anxiolytic use, unspecified with intoxication, unspecified

F13.930 Sedative, hypnotic or anxiolytic use, unspecified with withdrawal, uncomplicated

F13.931 Sedative, hypnotic or anxiolytic use, unspecified with withdrawal delirium

F13.932 Sedative, hypnotic or anxiolytic use, unspecified with withdrawal with perceptual disturbances

F13.939 Sedative, hypnotic or anxiolytic use, unspecified with withdrawal, unspecified

F13.94 Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced mood disorder

F13.950 Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced psychotic disorder with delusions

F13.951 Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced psychotic disorder with hallucinations

F13.959 Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced psychotic disorder, unspecified

F13.96 Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced persisting amnestic disorder

F13.97 Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced persisting dementia

F13.980 Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced anxiety disorder

F13.981 Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced sexual dysfunction

F13.982 Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced sleep disorder

F13.988 Sedative, hypnotic or anxiolytic use, unspecified with other sedative, hypnotic or anxiolytic-induced disorder

F13.99 Sedative, hypnotic or anxiolytic use, unspecified with unspecified sedative, hypnotic or anxiolytic-induced disorder

F14.10 Cocaine abuse, uncomplicated

F14.120 Cocaine abuse with intoxication, uncomplicated

F14.121 Cocaine abuse with intoxication with delirium

F14.122 Cocaine abuse with intoxication with perceptual disturbance

F14.129 Cocaine abuse with intoxication, unspecified

F14.14 Cocaine abuse with cocaine-induced mood disorder

F14.150 Cocaine abuse with cocaine-induced psychotic disorder with delusions

F14.151 Cocaine abuse with cocaine-induced psychotic disorder with hallucinations

F14.159 Cocaine abuse with cocaine-induced psychotic disorder, unspecified

F14.180 Cocaine abuse with cocaine-induced anxiety disorder

F14.181 Cocaine abuse with cocaine-induced sexual dysfunction

F14.182 Cocaine abuse with cocaine-induced sleep disorder

F14.188 Cocaine abuse with other cocaine-induced disorder

F14.19 Cocaine abuse with unspecified cocaine-induced disorder

F14.20 Cocaine dependence, uncomplicated

F14.220 Cocaine dependence with intoxication, uncomplicated

F14.221 Cocaine dependence with intoxication delirium

F14.222 Cocaine dependence with intoxication with perceptual disturbance

F14.229 Cocaine dependence with intoxication, unspecified

F14.23 Cocaine dependence with withdrawal

F14.24 Cocaine dependence with cocaine-induced mood disorder

F14.250 Cocaine dependence with cocaine-induced psychotic disorder with delusions

F14.251 Cocaine dependence with cocaine-induced psychotic disorder with hallucinations

F14.259 Cocaine dependence with cocaine-induced psychotic disorder, unspecified

F14.280 Cocaine dependence with cocaine-induced anxiety disorder

F14.281 Cocaine dependence with cocaine-induced sexual dysfunction

F14.282 Cocaine dependence with cocaine-induced sleep disorder

F14.288 Cocaine dependence with other cocaine-induced disorder

F14.29 Cocaine dependence with unspecified cocaine-induced disorder

F14.90 Cocaine use, unspecified, uncomplicated

F14.920 Cocaine use, unspecified with intoxication, uncomplicated

F14.921 Cocaine use, unspecified with intoxication delirium

F14.922 Cocaine use, unspecified with intoxication with perceptual disturbance

F14.929 Cocaine use, unspecified with intoxication, unspecified

F14.94 Cocaine use, unspecified with cocaine-induced mood disorder

F14.950 Cocaine use, unspecified with cocaine-induced psychotic disorder with delusions

F14.951 Cocaine use, unspecified with cocaine-induced psychotic disorder with hallucinations

F14.959 Cocaine use, unspecified with cocaine-induced psychotic disorder, unspecified

F14.980 Cocaine use, unspecified with cocaine-induced anxiety disorder

F14.981 Cocaine use, unspecified with cocaine-induced sexual dysfunction

F14.982 Cocaine use, unspecified with cocaine-induced sleep disorder

F14.988 Cocaine use, unspecified with other cocaine-induced disorder

F14.99 Cocaine use, unspecified with unspecified cocaine-induced disorder

F15.10 Other stimulant abuse, uncomplicated

F15.120 Other stimulant abuse with intoxication, uncomplicated

F15.121 Other stimulant abuse with intoxication delirium

F15.122 Other stimulant abuse with intoxication with perceptual disturbance

F15.129 Other stimulant abuse with intoxication, unspecified

F15.14 Other stimulant abuse with stimulant-induced mood disorder

F15.150 Other stimulant abuse with stimulant-induced psychotic disorder with delusions

F15.151 Other stimulant abuse with stimulant-induced psychotic disorder with hallucinations

F15.159 Other stimulant abuse with stimulant-induced psychotic disorder, unspecified

F15.180 Other stimulant abuse with stimulant-induced anxiety disorder

F15.181 Other stimulant abuse with stimulant-induced sexual dysfunction

F15.182 Other stimulant abuse with stimulant-induced sleep disorder

F15.188 Other stimulant abuse with other stimulant-induced disorder

F15.19 Other stimulant abuse with unspecified stimulant-induced disorder

F15.20 Other stimulant dependence, uncomplicated

F15.220 Other stimulant dependence with intoxication, uncomplicated

F15.221 Other stimulant dependence with intoxication delirium

F15.222 Other stimulant dependence with intoxication with perceptual disturbance

F15.229 Other stimulant dependence with intoxication, unspecified

F15.23 Other stimulant dependence with withdrawal

F15.24 Other stimulant dependence with stimulant-induced mood disorder

F15.250 Other stimulant dependence with stimulant-induced psychotic disorder with delusions

F15.251 Other stimulant dependence with stimulant-induced psychotic disorder with hallucinations

F15.259 Other stimulant dependence with stimulant-induced psychotic disorder, unspecified

F15.280 Other stimulant dependence with stimulant-induced anxiety disorder

F15.281 Other stimulant dependence with stimulant-induced sexual dysfunction

F15.282 Other stimulant dependence with stimulant-induced sleep disorder

F15.288 Other stimulant dependence with other stimulant-induced disorder

F15.29 Other stimulant dependence with unspecified stimulant-induced disorder

F15.90 Other stimulant use, unspecified, uncomplicated

F15.920 Other stimulant use, unspecified with intoxication, uncomplicated

F15.921 Other stimulant use, unspecified with intoxication delirium

F15.922 Other stimulant use, unspecified with intoxication with perceptual disturbance

F15.929 Other stimulant use, unspecified with intoxication, unspecified

F15.93 Other stimulant use, unspecified with withdrawal

F15.94 Other stimulant use, unspecified with stimulant-induced mood disorder

F15.950 Other stimulant use, unspecified with stimulant-induced psychotic disorder with delusions

F15.951 Other stimulant use, unspecified with stimulant-induced psychotic disorder with hallucinations

F15.959 Other stimulant use, unspecified with stimulant-induced psychotic disorder, unspecified

F15.980 Other stimulant use, unspecified with stimulant-induced anxiety disorder

F15.981 Other stimulant use, unspecified with stimulant-induced sexual dysfunction

F15.982 Other stimulant use, unspecified with stimulant-induced sleep disorder

F15.988 Other stimulant use, unspecified with other stimulant-induced disorder

F15.99 Other stimulant use, unspecified with unspecified stimulant-induced disorder

F19.10 Other psychoactive substance abuse, uncomplicated

F19.120 Other psychoactive substance abuse with intoxication, uncomplicated

F19.121 Other psychoactive substance abuse with intoxication delirium

F19.122 Other psychoactive substance abuse with intoxication with perceptual disturbances

F19.129 Other psychoactive substance abuse with intoxication, unspecified

F19.14 Other psychoactive substance abuse with psychoactive substance-induced mood disorder

F19.150 Other psychoactive substance abuse with psychoactive substance-induced psychotic disorder with delusions

F19.151 Other psychoactive substance abuse with psychoactive substance-induced psychotic disorder with hallucinations

F19.159 Other psychoactive substance abuse with psychoactive substance-induced psychotic disorder, unspecified

F19.16 Other psychoactive substance abuse with psychoactive substance-induced persisting amnestic disorder

F19.17 Other psychoactive substance abuse with psychoactive substance-induced persisting dementia

F19.180 Other psychoactive substance abuse with psychoactive substance-induced anxiety disorder

F19.181 Other psychoactive substance abuse with psychoactive substance-induced sexual dysfunction

F19.182 Other psychoactive substance abuse with psychoactive substance-induced sleep disorder

F19.188 Other psychoactive substance abuse with other psychoactive substance-induced disorder

F19.19 Other psychoactive substance abuse with unspecified psychoactive substance-induced disorder

Z00.00 Encounter for general adult medical examination without abnormal findings

Z00.01 Encounter for general adult medical examination with abnormal findings

Z00.121 Encounter for routine child health examination with abnormal findings

Z00.129 Encounter for routine child health examination without abnormal findings

Z11.3 Encounter for screening for infections with a predominantly sexual mode of transmission

Z11.59 Encounter for screening for other viral diseases

Z20.2 Contact with and (suspected) exposure to infections with a predominantly sexual mode of transmission

Z20.5 Contact with and (suspected) exposure to viral hepatitis

Z21 Asymptomatic human immunodeficiency virus

Z28.3 Underimmunization status

Z72.52 High risk homosexual behavior

Z72.53 High risk bisexual behavior

Z79.899 Other long term (current) drug therapy

Z92.21 Personal history of antineoplastic chemotherapy

Z92.25 Personal history of immunosuppression therapy

Z99.2 Dependence on renal dialysis

HCPCS Level II Code Number(s) and Narrative(s) G0499 Hepatitis B screening in non-pregnant, high risk individual includes hepatitis B surface antigen (HBSAG) followed by a neutralizing confirmatory test for initially reactive results, and antibodies to HBSAG (anti-HBS) and hepatitis B core antigen (anti-HBC)

HEPATITIS C VIRUS SCREENING
Hepatitis C virus screening is covered as a preventive service for any of the following criteria:
  • All asymptomatic adults, 18 years of age or older at high risk for infection with no history of liver disease or functional abnormalities
    • High risk for Hepatitis C virus infections are any of the following:
      • Individual who is a past or current injection drug user
      • Individual who was a recipient of a blood transfusion before 1992
      • Individual who is on long term hemodialysis
      • Individual who was born to Hepatitis C positive mother
      • Individual who is incarcerated
      • Individual who is intranasal drug user
      • Individual who have high risk sexual behaviors
      • Individual who had percutaneous exposures
  • One-time screening for those born between 1945 and 1965
CPT Procedure Code Number(s) and Narrative(s)
86803, 87522

WHEN THE FOLLOWING CODES ARE REPORTED IN CONJUNCTION WITH HEPATITIS C VIRUS SCREENING, THEY ARE COVERED AS A PREVENTIVE SERVICE:

36415, 36416, 99000
ICD-10 Diagnosis Code Number(s) and Narrative(s) FOR HEPATITIS C VIRUS SCREENING, CPT CODES 86803, 87522 AND HCPCS CODE G0472 WILL ONLY BE COVERED AS A PREVENTIVE SERVICE FOR THE FOLLOWING DIAGNOSIS CODE:

F11.10 Opioid abuse, uncomplicated

F11.11 Opioid abuse, in remission

F11.120 Opioid abuse with intoxication, uncomplicated

F11.121 Opioid abuse with intoxication delirium

F11.122 Opioid abuse with intoxication with perceptual disturbance

F11.129 Opioid abuse with intoxication, unspecified

F11.14 Opioid abuse with opioid-induced mood disorder

F11.150 Opioid abuse with opioid-induced psychotic disorder with delusions

F11.151 Opioid abuse with opioid-induced psychotic disorder with hallucinations

F11.159 Opioid abuse with opioid-induced psychotic disorder, unspecified

F11.181 Opioid abuse with opioid-induced sexual dysfunction

F11.182 Opioid abuse with opioid-induced sleep disorder

F11.188 Opioid abuse with other opioid-induced disorder

F11.19 Opioid abuse with unspecified opioid-induced disorder

F11.20 Opioid dependence, uncomplicated

F11.21 Opioid dependence, in remission

F11.220 Opioid dependence with intoxication, uncomplicated

F11.221 Opioid dependence with intoxication delirium

F11.222 Opioid dependence with intoxication with perceptual disturbance

F11.229 Opioid dependence with intoxication, unspecified

F11.23 Opioid dependence with withdrawal

F11.24 Opioid dependence with opioid-induced mood disorder

F11.250 Opioid dependence with opioid-induced psychotic disorder with delusions

F11.251 Opioid dependence with opioid-induced psychotic disorder with hallucinations

F11.259 Opioid dependence with opioid-induced psychotic disorder, unspecified

F11.281 Opioid dependence with opioid-induced sexual dysfunction

F11.282 Opioid dependence with opioid-induced sleep disorder

F11.288 Opioid dependence with other opioid-induced disorder

F11.29 Opioid dependence with unspecified opioid-induced disorder

F11.90 Opioid use, unspecified, uncomplicated

F11.920 Opioid use, unspecified with intoxication, uncomplicated

F11.921 Opioid use, unspecified with intoxication delirium

F11.922 Opioid use, unspecified with intoxication with perceptual disturbance

F11.929 Opioid use, unspecified with intoxication, unspecified

F11.93 Opioid use, unspecified with withdrawal

F11.94 Opioid use, unspecified with opioid-induced mood disorder

F11.950 Opioid use, unspecified with opioid-induced psychotic disorder with delusions

F11.951 Opioid use, unspecified with opioid-induced psychotic disorder with hallucinations

F11.959 Opioid use, unspecified with opioid-induced psychotic disorder, unspecified

F11.981 Opioid use, unspecified with opioid-induced sexual dysfunction

F11.982 Opioid use, unspecified with opioid-induced sleep disorder

F11.988 Opioid use, unspecified with other opioid-induced disorder

F11.99 Opioid use, unspecified with unspecified opioid-induced disorder

F13.10 Sedative, hypnotic or anxiolytic abuse, uncomplicated

F13.11 Sedative, hypnotic or anxiolytic abuse, in remission

F13.120 Sedative, hypnotic or anxiolytic abuse with intoxication, uncomplicated

F13.121 Sedative, hypnotic or anxiolytic abuse with intoxication delirium

F13.129 Sedative, hypnotic or anxiolytic abuse with intoxication, unspecified

F13.14 Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced mood disorder

F13.150 Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced psychotic disorder with delusions

F13.151 Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced psychotic disorder with hallucinations

F13.159 Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced psychotic disorder, unspecified

F13.180 Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced anxiety disorder

F13.181 Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced sexual dysfunction

F13.182 Sedative, hypnotic or anxiolytic abuse with sedative, hypnotic or anxiolytic-induced sleep disorder

F13.188 Sedative, hypnotic or anxiolytic abuse with other sedative, hypnotic or anxiolytic-induced disorder

F13.19 Sedative, hypnotic or anxiolytic abuse with unspecified sedative, hypnotic or anxiolytic-induced disorder

F13.20 Sedative, hypnotic or anxiolytic dependence, uncomplicated

F13.21 Sedative, hypnotic or anxiolytic dependence, in remission

F13.220 Sedative, hypnotic or anxiolytic dependence with intoxication, uncomplicated

F13.221 Sedative, hypnotic or anxiolytic dependence with intoxication delirium

F13.229 Sedative, hypnotic or anxiolytic dependence with intoxication, unspecified

F13.230 Sedative, hypnotic or anxiolytic dependence with withdrawal, uncomplicated

F13.231 Sedative, hypnotic or anxiolytic dependence with withdrawal delirium

F13.232 Sedative, hypnotic or anxiolytic dependence with withdrawal with perceptual disturbance

F13.239 Sedative, hypnotic or anxiolytic dependence with withdrawal, unspecified

F13.24 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced mood disorder

F13.250 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced psychotic disorder with delusions

F13.251 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced psychotic disorder with hallucinations

F13.259 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced psychotic disorder, unspecified

F13.26 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced persisting amnestic disorder

F13.27 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced persisting dementia

F13.280 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced anxiety disorder

F13.281 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced sexual dysfunction

F13.282 Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced sleep disorder

F13.288 Sedative, hypnotic or anxiolytic dependence with other sedative, hypnotic or anxiolytic-induced disorder

F13.29 Sedative, hypnotic or anxiolytic dependence with unspecified sedative, hypnotic or anxiolytic-induced disorder

F13.90 Sedative, hypnotic, or anxiolytic use, unspecified, uncomplicated

F13.920 Sedative, hypnotic or anxiolytic use, unspecified with intoxication, uncomplicated

F13.921 Sedative, hypnotic or anxiolytic use, unspecified with intoxication delirium

F13.929 Sedative, hypnotic or anxiolytic use, unspecified with intoxication, unspecified

F13.930 Sedative, hypnotic or anxiolytic use, unspecified with withdrawal, uncomplicated

F13.931 Sedative, hypnotic or anxiolytic use, unspecified with withdrawal delirium

F13.932 Sedative, hypnotic or anxiolytic use, unspecified with withdrawal with perceptual disturbances

F13.939 Sedative, hypnotic or anxiolytic use, unspecified with withdrawal, unspecified

F13.94 Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced mood disorder

F13.950 Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced psychotic disorder with delusions

F13.951 Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced psychotic disorder with hallucinations

F13.959 Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced psychotic disorder, unspecified

F13.96 Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced persisting amnestic disorder

F13.97 Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced persisting dementia

F13.980 Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced anxiety disorder

F13.981 Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced sexual dysfunction

F13.982 Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced sleep disorder

F13.988 Sedative, hypnotic or anxiolytic use, unspecified with other sedative, hypnotic or anxiolytic-induced disorder

F13.99 Sedative, hypnotic or anxiolytic use, unspecified with unspecified sedative, hypnotic or anxiolytic-induced disorder

F14.10 Cocaine abuse, uncomplicated

F14.11 Cocaine abuse, in remission

F14.120 Cocaine abuse with intoxication, uncomplicated

F14.121 Cocaine abuse with intoxication with delirium

F14.122 Cocaine abuse with intoxication with perceptual disturbance

F14.129 Cocaine abuse with intoxication, unspecified

F14.14 Cocaine abuse with cocaine-induced mood disorder

F14.150 Cocaine abuse with cocaine-induced psychotic disorder with delusions

F14.151 Cocaine abuse with cocaine-induced psychotic disorder with hallucinations

F14.159 Cocaine abuse with cocaine-induced psychotic disorder, unspecified

F14.180 Cocaine abuse with cocaine-induced anxiety disorder

F14.181 Cocaine abuse with cocaine-induced sexual dysfunction

F14.182 Cocaine abuse with cocaine-induced sleep disorder

F14.188 Cocaine abuse with other cocaine-induced disorder

F14.19 Cocaine abuse with unspecified cocaine-induced disorder

F14.20 Cocaine dependence, uncomplicated

F14.21 Cocaine dependence, in remission

F14.220 Cocaine dependence with intoxication, uncomplicated

F14.221 Cocaine dependence with intoxication delirium

F14.222 Cocaine dependence with intoxication with perceptual disturbance

F14.229 Cocaine dependence with intoxication, unspecified

F14.23 Cocaine dependence with withdrawal

F14.24 Cocaine dependence with cocaine-induced mood disorder

F14.250 Cocaine dependence with cocaine-induced psychotic disorder with delusions

F14.251 Cocaine dependence with cocaine-induced psychotic disorder with hallucinations

F14.259 Cocaine dependence with cocaine-induced psychotic disorder, unspecified

F14.280 Cocaine dependence with cocaine-induced anxiety disorder

F14.281 Cocaine dependence with cocaine-induced sexual dysfunction

F14.282 Cocaine dependence with cocaine-induced sleep disorder

F14.288 Cocaine dependence with other cocaine-induced disorder

F14.29 Cocaine dependence with unspecified cocaine-induced disorder

F14.90 Cocaine use, unspecified, uncomplicated

F14.920 Cocaine use, unspecified with intoxication, uncomplicated

F14.921 Cocaine use, unspecified with intoxication delirium

F14.922 Cocaine use, unspecified with intoxication with perceptual disturbance

F14.929 Cocaine use, unspecified with intoxication, unspecified

F14.94 Cocaine use, unspecified with cocaine-induced mood disorder

F14.950 Cocaine use, unspecified with cocaine-induced psychotic disorder with delusions

F14.951 Cocaine use, unspecified with cocaine-induced psychotic disorder with hallucinations

F14.959 Cocaine use, unspecified with cocaine-induced psychotic disorder, unspecified

F14.980 Cocaine use, unspecified with cocaine-induced anxiety disorder

F14.981 Cocaine use, unspecified with cocaine-induced sexual dysfunction

F14.982 Cocaine use, unspecified with cocaine-induced sleep disorder

F14.988 Cocaine use, unspecified with other cocaine-induced disorder

F14.99 Cocaine use, unspecified with unspecified cocaine-induced disorder

F15.10 Other stimulant abuse, uncomplicated

F15.11 Other stimulant abuse, in remission

F15.120 Other stimulant abuse with intoxication, uncomplicated

F15.121 Other stimulant abuse with intoxication delirium

F15.122 Other stimulant abuse with intoxication with perceptual disturbance

F15.129 Other stimulant abuse with intoxication, unspecified

F15.14 Other stimulant abuse with stimulant-induced mood disorder

F15.150 Other stimulant abuse with stimulant-induced psychotic disorder with delusions

F15.151 Other stimulant abuse with stimulant-induced psychotic disorder with hallucinations

F15.159 Other stimulant abuse with stimulant-induced psychotic disorder, unspecified

F15.180 Other stimulant abuse with stimulant-induced anxiety disorder

F15.181 Other stimulant abuse with stimulant-induced sexual dysfunction

F15.182 Other stimulant abuse with stimulant-induced sleep disorder

F15.188 Other stimulant abuse with other stimulant-induced disorder

F15.19 Other stimulant abuse with unspecified stimulant-induced disorder

F15.20 Other stimulant dependence, uncomplicated

F15.21 Other stimulant dependence, in remission

F15.220 Other stimulant dependence with intoxication, uncomplicated

F15.221 Other stimulant dependence with intoxication delirium

F15.222 Other stimulant dependence with intoxication with perceptual disturbance

F15.229 Other stimulant dependence with intoxication, unspecified

F15.23 Other stimulant dependence with withdrawal

F15.24 Other stimulant dependence with stimulant-induced mood disorder

F15.250 Other stimulant dependence with stimulant-induced psychotic disorder with delusions

F15.251 Other stimulant dependence with stimulant-induced psychotic disorder with hallucinations

F15.259 Other stimulant dependence with stimulant-induced psychotic disorder, unspecified

F15.280 Other stimulant dependence with stimulant-induced anxiety disorder

F15.281 Other stimulant dependence with stimulant-induced sexual dysfunction

F15.282 Other stimulant dependence with stimulant-induced sleep disorder

F15.288 Other stimulant dependence with other stimulant-induced disorder

F15.29 Other stimulant dependence with unspecified stimulant-induced disorder

F15.90 Other stimulant use, unspecified, uncomplicated

F15.920 Other stimulant use, unspecified with intoxication, uncomplicated

F15.921 Other stimulant use, unspecified with intoxication delirium

F15.922 Other stimulant use, unspecified with intoxication with perceptual disturbance

F15.929 Other stimulant use, unspecified with intoxication, unspecified

F15.93 Other stimulant use, unspecified with withdrawal

F15.94 Other stimulant use, unspecified with stimulant-induced mood disorder

F15.950 Other stimulant use, unspecified with stimulant-induced psychotic disorder with delusions

F15.951 Other stimulant use, unspecified with stimulant-induced psychotic disorder with hallucinations

F15.959 Other stimulant use, unspecified with stimulant-induced psychotic disorder, unspecified

F15.980 Other stimulant use, unspecified with stimulant-induced anxiety disorder

F15.981 Other stimulant use, unspecified with stimulant-induced sexual dysfunction

F15.982 Other stimulant use, unspecified with stimulant-induced sleep disorder

F15.988 Other stimulant use, unspecified with other stimulant-induced disorder

F15.99 Other stimulant use, unspecified with unspecified stimulant-induced disorder

F16.10 Hallucinogen abuse, uncomplicated

F16.11 Hallucinogen abuse, in remission

F16.120 Hallucinogen abuse with intoxication, uncomplicated

F16.121 Hallucinogen abuse with intoxication with delirium

F16.122 Hallucinogen abuse with intoxication with perceptual disturbance

F16.129 Hallucinogen abuse with intoxication, unspecified

F16.14 Hallucinogen abuse with hallucinogen-induced mood disorder

F16.150 Hallucinogen abuse with hallucinogen-induced psychotic disorder with delusions

F16.151 Hallucinogen abuse with hallucinogen-induced psychotic disorder with hallucinations

F16.159 Hallucinogen abuse with hallucinogen-induced psychotic disorder, unspecified

F16.180 Hallucinogen abuse with hallucinogen-induced anxiety disorder

F16.183 Hallucinogen abuse with hallucinogen persisting perception disorder (flashbacks)

F16.188 Hallucinogen abuse with other hallucinogen-induced disorder

F16.19 Hallucinogen abuse with unspecified hallucinogen-induced disorder

F16.20 Hallucinogen dependence, uncomplicated

F16.21 Hallucinogen dependence, in remission

F16.220 Hallucinogen dependence with intoxication, uncomplicated

F16.221 Hallucinogen dependence with intoxication with delirium

F16.229 Hallucinogen dependence with intoxication, unspecified

F16.24 Hallucinogen dependence with hallucinogen-induced mood disorder

F16.250 Hallucinogen dependence with hallucinogen-induced psychotic disorder with delusions

F16.251 Hallucinogen dependence with hallucinogen-induced psychotic disorder with hallucinations

F16.259 Hallucinogen dependence with hallucinogen-induced psychotic disorder, unspecified

F16.280 Hallucinogen dependence with hallucinogen-induced anxiety disorder

F16.283 Hallucinogen dependence with hallucinogen persisting perception disorder (flashbacks)

F16.288 Hallucinogen dependence with other hallucinogen-induced disorder

F16.29 Hallucinogen dependence with unspecified hallucinogen-induced disorder

F16.90 Hallucinogen use, unspecified, uncomplicated

F16.920 Hallucinogen use, unspecified with intoxication, uncomplicated

F16.921 Hallucinogen use, unspecified with intoxication with delirium

F16.929 Hallucinogen use, unspecified with intoxication, unspecified

F16.94 Hallucinogen use, unspecified with hallucinogen-induced mood disorder

F16.950 Hallucinogen use, unspecified with hallucinogen-induced psychotic disorder with delusions

F16.951 Hallucinogen use, unspecified with hallucinogen-induced psychotic disorder with hallucinations

F16.959 Hallucinogen use, unspecified with hallucinogen-induced psychotic disorder, unspecified

F16.980 Hallucinogen use, unspecified with hallucinogen-induced anxiety disorder

F16.983 Hallucinogen use, unspecified with hallucinogen persisting perception disorder (flashbacks)

F16.988 Hallucinogen use, unspecified with other hallucinogen-induced disorder

F16.99 Hallucinogen use, unspecified with unspecified hallucinogen-induced disorder

F18.10 Inhalant abuse, uncomplicated

F18.11 Inhalant abuse, in remission

F18.120 Inhalant abuse with intoxication, uncomplicated

F18.121 Inhalant abuse with intoxication delirium

F18.129 Inhalant abuse with intoxication, unspecified

F18.14 Inhalant abuse with inhalant-induced mood disorder

F18.150 Inhalant abuse with inhalant-induced psychotic disorder with delusions

F18.151 Inhalant abuse with inhalant-induced psychotic disorder with hallucinations

F18.159 Inhalant abuse with inhalant-induced psychotic disorder, unspecified

F18.17 Inhalant abuse with inhalant-induced dementia

F18.180 Inhalant abuse with inhalant-induced anxiety disorder

F18.188 Inhalant abuse with other inhalant-induced disorder

F18.19 Inhalant abuse with unspecified inhalant-induced disorder

F18.20 Inhalant dependence, uncomplicated

F18.21 Inhalant dependence, in remission

F18.220 Inhalant dependence with intoxication, uncomplicated

F18.221 Inhalant dependence with intoxication delirium

F18.229 Inhalant dependence with intoxication, unspecified

F18.24 Inhalant dependence with inhalant-induced mood disorder

F18.250 Inhalant dependence with inhalant-induced psychotic disorder with delusions

F18.251 Inhalant dependence with inhalant-induced psychotic disorder with hallucinations

F18.259 Inhalant dependence with inhalant-induced psychotic disorder, unspecified

F18.27 Inhalant dependence with inhalant-induced dementia

F18.280 Inhalant dependence with inhalant-induced anxiety disorder

F18.288 Inhalant dependence with other inhalant-induced disorder

F18.29 Inhalant dependence with unspecified inhalant-induced disorder

F18.90 Inhalant use, unspecified, uncomplicated

F18.920 Inhalant use, unspecified with intoxication, uncomplicated

F18.921 Inhalant use, unspecified with intoxication with delirium

F18.929 Inhalant use, unspecified with intoxication, unspecified

F18.94 Inhalant use, unspecified with inhalant-induced mood disorder

F18.950 Inhalant use, unspecified with inhalant-induced psychotic disorder with delusions

F18.951 Inhalant use, unspecified with inhalant-induced psychotic disorder with hallucinations

F18.959 Inhalant use, unspecified with inhalant-induced psychotic disorder, unspecified

F18.97 Inhalant use, unspecified with inhalant-induced persisting dementia

F18.980 Inhalant use, unspecified with inhalant-induced anxiety disorder

F18.988 Inhalant use, unspecified with other inhalant-induced disorder

F18.99 Inhalant use, unspecified with unspecified inhalant-induced disorder

F19.10 Other psychoactive substance abuse, uncomplicated

F19.11 Other psychoactive substance abuse, in remission

F19.120 Other psychoactive substance abuse with intoxication, uncomplicated

F19.121 Other psychoactive substance abuse with intoxication delirium

F19.122 Other psychoactive substance abuse with intoxication with perceptual disturbances

F19.129 Other psychoactive substance abuse with intoxication, unspecified

F19.14 Other psychoactive substance abuse with psychoactive substance-induced mood disorder

F19.150 Other psychoactive substance abuse with psychoactive substance-induced psychotic disorder with delusions

F19.151 Other psychoactive substance abuse with psychoactive substance-induced psychotic disorder with hallucinations

F19.159 Other psychoactive substance abuse with psychoactive substance-induced psychotic disorder, unspecified

F19.16 Other psychoactive substance abuse with psychoactive substance-induced persisting amnestic disorder

F19.17 Other psychoactive substance abuse with psychoactive substance-induced persisting dementia

F19.180 Other psychoactive substance abuse with psychoactive substance-induced anxiety disorder

F19.181 Other psychoactive substance abuse with psychoactive substance-induced sexual dysfunction

F19.182 Other psychoactive substance abuse with psychoactive substance-induced sleep disorder

F19.188 Other psychoactive substance abuse with other psychoactive substance-induced disorder

F19.19 Other psychoactive substance abuse with unspecified psychoactive substance-induced disorder

P00.2 Newborn affected by maternal infectious and parasitic diseases

W46.0XXA Contact with hypodermic needle, initial encounter

W46.0XXD Contact with hypodermic needle, subsequent encounter

W46.0XXS Contact with hypodermic needle, sequela

W46.1XXA Contact with contaminated hypodermic needle, initial encounter

W46.1XXD Contact with contaminated hypodermic needle, subsequent encounter

W46.1XXS Contact with contaminated hypodermic needle, sequela

Z00.00 Encounter for general adult medical examination without abnormal findings

Z00.01 Encounter for general adult medical examination with abnormal findings

Z11.3 Encounter for screening for infections with a predominantly sexual mode of transmission

Z11.59 Encounter for screening for other viral diseases

Z20.5 Contact with and (suspected) exposure to viral hepatitis

Z65.1 Imprisonment and other incarceration

Z72.51 High risk heterosexual behavior

Z72.52 High risk homosexual behavior

Z72.53 High risk bisexual behavior

Z77.21 Contact with and (suspected) exposure to potentially hazardous body fluids

Z86.59 Personal history of other mental and behavioral disorders

Z99.2 Dependence on renal dialysis

HCPCS Level II Code Number(s) and Narrative(s) G0472 Hepatitis C antibody screening for individual at high risk and other covered indication(s)

HIGH BLOOD PRESSURE SCREENING
Ambulatory blood pressure monitoring is covered as a preventive service for individuals with an elevated office blood pressure without known hypertension when any of the following is met:
  • For individuals 18 years and older with an increased risk for high blood pressure once a year
  • For individuals 18 to 39 years with no other risk factors once every three to five years
  • For Individuals 40 years or older once a year

As an alternative, a home blood pressure device may be covered as a preventive service when the above criteria is met.

CPT Procedure Code Number(s) and Narrative(s) 93784, 93786, 93788, 93790, 99473, 99474
ICD-10 Diagnosis Code Number(s) and Narrative(s) FOR BLOOD PRESSURE MONITORING, CPT CODES 93784, 93786, 93788, 93790 AND HCPCS CODES A4663 AND A4670 WILL ONLY BE COVERED AS A PREVENTIVE SERVICE FOR THE FOLLOWING DIAGNOSIS CODE:

R03.0 Elevated blood-pressure reading, without diagnosis of hypertension
HCPCS Level II Code Number(s) and Narrative(s) A4663 Blood pressure cuff only

A4670 Automatic blood pressure monitor

HUMAN IMMUNODEFICIENCY VIRUS (HIV) SCREENING
Human immunodeficiency virus (HIV) screening is covered as a preventive service for individuals 15 to 65 years of age. HIV screening is covered as a preventive services for individuals younger than 15 years of age or older than 65 years of age who are at increased risk for HIV.

CPT Procedure Code Number(s) and Narrative(s)
86689, 86701, 86702, 86703, 87389, 87390, 87391, 87806

WHEN THE FOLLOWING CODES ARE REPORTED IN CONJUNCTION WITH HIV SCREENING, THEY ARE COVERED AS A PREVENTIVE SERVICE:

36415, 36416, 99000
ICD-10 Diagnosis Code Number(s) and Narrative(s) FOR HIV SCREENING, CPT CODES 86689, 86701, 86702, 86703, 87389, 87390, 87391, 87806 WILL ONLY BE COVERED AS A PREVENTIVE SERVICE FOR THE FOLLOWING DIAGNOSIS CODES:

Z00.00 Encounter for general adult medical examination without abnormal findings

Z00.01 Encounter for general adult medical examination with abnormal findings

Z11.3 Encounter for screening for infections with a predominantly sexual mode of transmission

Z11.4 Encounter for screening for human immunodeficiency virus [HIV]
HCPCS Level II Code Number(s) and Narrative(s) G0432 Infectious agent antibody detection by enzyme immunoassay (EIA) technique, HIV-1 and/or HIV-2, screening

G0433 Infectious agent antibody detection by enzyme-linked immunosorbent assay (ELISA) technique, HIV-1 and/or HIV-2, screening

G0435 Infectious agent antigen detection by rapid antibody test of oral mucosa transudate, HIV-1 or HIV-2, screening

G0475 HIV antigen/antibody, combination assay, screening

S3645 HIV-1 antibody testing of oral mucosal transudate

LATENT TUBERCULOSIS INFECTION SCREENING
Annual latent tuberculosis (TB) Infection Screening is covered as a preventive service for asymptomatic individuals age 18 years or older at increased risk for tuberculosis.

High risk factors for TB infections are any of the following:
  • Individuals born in or is a former resident of countries with increased TB prevalence
  • Individuals who live in or have lived in high risk congregate settings (e.g. homeless shelters and correctional facilities)
  • Individual who is immunosuppressed
  • Individual with silicosis
CPT Procedure Code Number(s) and Narrative(s) 86580

THE FOLLOWING CODE WILL BE COVERED AS A PREVENTIVE SERVICE WHEN REPORTED FOR THE FOLLOW-UP TO READ THE TUBERCULOSIS TEST RESULTS:

99211
ICD-10 Diagnosis Code Number(s) and Narrative(s) FOR TUBERCULOSIS TESTING, CPT CODE 99211 WILL ONLY BE COVERED AS A PREVENTIVE SERVICE FOR THE FOLLOWING DIAGNOSIS CODES:

R76.11 Nonspecific reaction to tuberculin skin test without active tuberculosis

Z11.1 Encounter for screening for respiratory tuberculosis

Z11.7 Encounter for testing for latent tuberculosis infection
HCPCS Level II Code Number(s) and Narrative(s) N/A

LIPID DISORDER SCREENING
Lipid disorder screening is covered as a preventive service for individuals 40 years or older every 5 years.

CPT Procedure Code Number(s) and Narrative(s) 80061, 82465, 83718, 83721, 84478

WHEN THE FOLLOWING CODES ARE REPORTED IN CONJUNCTION WITH LIPID DISORDER SCREENING, THEY ARE COVERED AS A PREVENTIVE SERVICE:

36415, 36416, 99000
ICD-10 Diagnosis Code Number(s) and Narrative(s) FOR LIPID DISORDER SCREENING, CPT CODES 80061, 82465, 83718, 83721, AND 84478 ARE COVERED AS PREVENTIVE FOR THE FOLLOWING DIAGNOSIS CODES:

Z00.00 Encounter for general adult medical examination without abnormal findings

Z00.01 Encounter for general adult medical examination with abnormal findings

Z13.220 Encounter for screening for lipoid disorders
HCPCS Level II Code Number(s) and Narrative(s) N/A

LUNG CANCER SCREENING
Lung cancer screening with low-dose computed tomography is covered as a preventive service for adults ages 55 to 80 years who have a 30 pack-year smoking history (number of pack-years = packs smoked per day × years as a smoker) and currently smoke or have quit within the past 15 years.

CPT Procedure Code Number(s) and Narrative(s) N/A
ICD-10 Diagnosis Code Number(s) and Narrative(s) FOR LUNG CANCER SCREENING, HCPCS G0297 WILL BE COVERED AS A PREVENTIVE SERVICE WITH THE FOLLOWING DIAGNOSIS CODES:

F17.210 Nicotine dependence, cigarettes, uncomplicated

F17.211 Nicotine dependence, cigarettes, in remission

F17.213 Nicotine dependence, cigarettes, with withdrawal

F17.218 Nicotine dependence, cigarettes, with other nicotine-induced disorders

F17.219 Nicotine dependence, cigarettes, with unspecified nicotine-induced disorders

Z72.0 Tobacco use

Z87.891 Personal history of nicotine dependence
HCPCS Level II Code Number(s) and Narrative(s) G0297 Low dose CT scan (LDCT) for lung cancer screening

SYPHILIS SCREENING
Syphilis screening is covered as a preventive service for all adults at increased risk for syphilis infection.

Risk factors for increased risk include:
  • Males who have sex with males
  • Individuals who are HIV positive
  • Individuals with a history of incarceration
  • Individuals with a history of commercial sex work
  • Males younger than 29 years
  • Individuals having sex with multiple partners
  • Individuals having a sexual partner who has tested positive for syphilis
CPT Procedure Code Number(s) and Narrative(s) 86592, 86780

WHEN THE FOLLOWING CODES ARE REPORTED IN CONJUNCTION WITH SYPHILIS SCREENING, THEY ARE COVERED AS A PREVENTIVE SERVICE:

36415, 36416, 99000
ICD-10 Diagnosis Code Number(s) and Narrative(s) FOR SYPHILIS SCREENING, CPT CODES 86592, 86780 WILL ONLY BE COVERED AS A PREVENTIVE SERVICE FOR THE FOLLOWING DIAGNOSIS CODE:

B20 Human immunodeficiency virus [HIV] disease

F52.8 Other sexual dysfunction not due to a substance or known physiological condition

Z00.00 Encounter for general adult medical examination without abnormal findings

Z00.01 Encounter for general adult medical examination with abnormal findings

Z00.121 Encounter for routine child health examination with abnormal findings

Z00.129 Encounter for routine child health examination without abnormal findings

Z11.2 Encounter for screening for other bacterial diseases

Z11.3 Encounter for screening for infections with a predominantly sexual mode of transmission

Z20.2 Contact with and (suspected) exposure to infections with a predominantly sexual mode of transmission

Z21 Asymptomatic human immunodeficiency virus

Z65.1 Imprisonment and other incarceration

Z72.51 High risk heterosexual behavior

Z72.52 High risk homosexual behavior

Z72.53 High risk bisexual behavior

Z77.21 Contact with and (suspected) exposure to potentially hazardous body fluids

Z91.42 Personal history of forced labor or sexual exploitation

HCPCS Level II Code Number(s) and Narrative(s) N/A

UNHEALTHY ALCOHOL USE SCREENING AND BEHAVIORAL COUNSELING INTERVENTIONS
Unhealthy alcohol use screening is covered as a preventive service for all adults. For adults who have a positive screening result for unhealthy alcohol use, behavioral counseling in a primary care setting is covered as a preventive service.

CPT Procedure Code Number(s) and Narrative(s)
99408, 99409
ICD-10 Diagnosis Code Number(s) and Narrative(s) N/A
HCPCS Level II Code Number(s) and Narrative(s) G0442 Annual alcohol misuse screening, 15 minutes

G0443 Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes

G2011 Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and brief intervention, 5-14 minutes


THERAPY AND COUNSELING

SERVICES INCLUDED AS PART OF THE COMPREHENSIVE PREVENTIVE EXAM
The following services are covered as part of a preventive exam and are not eligible for separate reimbursement:
  • Behavioral Counseling for Skin Cancer Prevention
  • High Blood Pressure Screening (office-based)
  • Obesity Screening

BEHAVIORAL COUNSELING FOR PREVENTION OF SEXUALLY TRANSMITTED INFECTIONS
Behavioral counseling for prevention of sexually transmitted infections is covered as a preventive service for all sexually active adults at increased risk for transmitted infections.

CPT Procedure Code Number(s) and Narrative(s) N/A
ICD-10 Diagnosis Code Number(s) and Narrative(s) N/A
HCPCS Level II Code Number(s) and Narrative(s) G0445 Semiannual high intensity behavioral counseling to prevent STIs, individual, face-to-face, includes education skills training & guidance on how to change sexual behavior

BEHAVIORAL INTERVENTIONS FOR WEIGHT LOSS
Intensive, multicomponent behavioral interventions (i.e. behavior based weight loss interventions and weight loss maintenance interventions) are covered as a preventive service for adults with a body mass index (BMI) of 30 kg/m2 or higher.
CPT Procedure Code Number(s) and Narrative(s) N/A
ICD-10 Diagnosis Code Number(s) and Narrative(s) FOR OBESITY SCREENING AND BEHAVIORAL COUNSELING, HCPCS G0447 WILL BE COVERED AS A PREVENTIVE SERVICE WITH THE FOLLOWING DIAGNOSIS CODES:

Z68.30 Body Mass Index (BMI) 30.0-30.9, adult

Z68.31 Body Mass Index (BMI) 31.0-31.9, adult

Z68.32 Body Mass Index (BMI) 32.0-32.9, adult

Z68.33 Body Mass Index (BMI) 33.0-33.9, adult

Z68.34 Body Mass Index (BMI) 34.0-34.9, adult

Z68.35 Body Mass Index (BMI) 35.0-35.9, adult

Z68.36 Body Mass Index (BMI) 36.0-36.9, adult

Z68.37 Body Mass Index (BMI) 37.0-37.9, adult

Z68.38 Body Mass Index (BMI) 38.0-38.9, adult

Z68.39 Body Mass Index (BMI) 39.0-39.9, adult

Z68.41 Body Mass Index (BMI) 40.0-44.9, adult

Z68.42 Body Mass Index (BMI) 45.0-49.9, adult

Z68.43 Body Mass Index (BMI) 50.0-59.9, adult

Z68.44 Body Mass Index (BMI) 60.0-69.9, adult

Z68.45 Body Mass Index (BMI) 70 or greater, adult
HCPCS Level II Code Number(s) and Narrative(s) G0447 Face-to-Face behavioral counseling for obesity, 15 minutes

EXERCISE INTERVENTIONS FOR THE PREVENTION OF FALLS
Exercise interventions for community-dwelling (i.e. not living in a facility) adults 65 years of age or older who are at increased risk for falls are covered as a preventive service when the following criteria are met:
  • The individual is not diagnosed with osteoporosis or vitamin D deficiency
  • The exercise interventions include at least one of the following components:
    • Gait training
    • Balance training
    • Functional training
    • Resistance training
    • Flexibility
    • Endurance training

Billing Requirements

Exercise interventions for the prevention of falls must be reported with the appropriate diagnosis code to represent increased risk for falls, the appropriate modifier (i.e. modifier 33), and the appropriate place of service code to indicate that the preventive coverage criteria has been met.

CPT Procedure Code Number(s) and Narrative(s) 97110, 97112, 97116, 97150, 97161, 97162, 97163, 97164, 97530
ICD-10 Diagnosis Code Number(s) and Narrative(s) R26.0 Ataxic gait
R26.1 Paralytic gait
R26.2 Difficulty in walking, not elsewhere classified
R26.81 Unsteadiness on feet
R26.89 Other abnormalities of gait and mobility
R26.9 Unspecified abnormalities of gait and mobility
R29.6 Repeated falls
Z91.81 History of falling
HCPCS Level II Code Number(s) and Narrative(s) N/A
Modifier(s) 33 Preventive Service

INTENSIVE BEHAVIORAL COUNSELING TO PROMOTE A HEALTHFUL DIET AND PHYSICAL ACTIVITIES FOR CARDIOVASCULAR DISEASE PREVENTION
Intensive behavioral counseling to promote a healthful diet and physical activity for cardiovascular disease prevention is covered as a preventive service when all of the following criteria are met:
  • Adults ages 18 years or older
  • Diagnosis of overweight or obese
  • Known cardiovascular disease risk factors including, but not limited to hypertension, dyslipidemia, impaired fasting glucose, or metabolic syndrome

Intensive behavioral counseling will be considered part of a preventive exam if less than 15 minutes.

CPT Procedure Code Number(s) and Narrative(s) N/A
ICD-10 Diagnosis Code Number(s) and Narrative(s) N/A
HCPCS Level II Code Number(s) and Narrative(s) G0446 Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes

NUTRITIONAL COUNSELING FOR WEIGHT MANAGEMENT
Nutritional counseling performed on a one to one basis (i.e. non-group setting) for weight management is covered as a preventive service for all adults up to 6 visits per year.
CPT Procedure Code Number(s) and Narrative(s) 97802, 97803
ICD-10 Diagnosis Code Number(s) and Narrative(s) N/A
HCPCS Level II Code Number(s) and Narrative(s) G0270 Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face-to-face with the patient, each 15 minutes

S9449 Weight management classes, nonphysician provider, per session

S9452 Nutrition classes, nonphysician provider, per session

S9470 Nutritional counseling, dietitian visit

TOBACCO USE COUNSELING
Counseling for tobacco use is covered as a preventive service for all adults who use tobacco products.

CPT Procedure Code Number(s) and Narrative(s)
99406, 99407
ICD-10 Diagnosis Code Number(s) and Narrative(s) N/A
HCPCS Level II Code Number(s) and Narrative(s) N/A

MEDICATIONS

Medications listed below are considered preventive when prescribed by a health care provider. For members without a pharmacy benefit, the following medications will be covered under their medical benefit if preventive criteria are met. Coverage of preventive medications under the member's medical benefit is contingent on the member submitting a receipt for the preventive medication. Cost-share may be applied to the branded preventive medication if there is an alternative generic medication available, unless a healthcare provider determines the generic is medically inappropriate.

LOW-DOSE ASPIRIN
Low-dose aspirin (81 mg per day) is covered as a preventive service for primary prevention of cardiovascular disease and colorectal cancer when all of the following criteria are met:
  • Individual who is 50 to 59 years of age
  • Individual with a 10-year cardiovascular risk of 10% or greater (based on the American College of Cardiology/American Heart Association guidelines on the assessment of cardiovascular risk)
  • Individual who does not have an increased risk for bleeding
  • Individual with a life expectancy of at least 10 years
  • The individual is willing to take low-dose aspirin for at least 10 years

PRESCRIPTION BOWEL PREPARATION MEDICATION
Prescription bowel preparation medications (i.e. PEG 3350- electrolyte, GavilyteC, Gavilyte-G, Gavilyte-N, Trilyte with flavor packets, Gavilyte-H with bisacodyl) are covered as a preventive service when used in conjunction with a preventive colorectal cancer screening procedure (i.e. flexible sigmoidoscopy, colonoscopy, virtual colonoscopy).

Over-the-counter medications or isotonic liquids used as bowel preparation medication will not be covered as a preventive service. PEG 3350, an over-the counter medication, is an exception. PEG 3350 is covered as a preventive service when used in conjunction with a preventive colorectal cancer screening procedure (i.e. flexible sigmoidoscopy, colonoscopy, virtual colonoscopy).

STATINS FOR THE PRIMARY PREVENTION OF CARDIOVASCULAR DISEASE
Lovastatin, the Company-designated low-to-moderate preventive statin, is covered as a preventive service for the prevention of cardiovascular disease and mortality when all the following criteria are met
  • Individual is 40 to 75 years of age
  • Individual has no history of cardiovascular disease
  • Individual with one or more cardiovascular disease risk factors (i.e. dyslipidemia, diabetes, hypertension, smoking)
  • Individual with a calculated 10-year risk of cardiovascular event of 10% or greater based on the American College of Cardiology/American Heart Association Pooled Cohort Equations

* Other statins for the primary prevention of cardiovascular disease are NOT considered a preventive service, unless a healthcare provider determines lovastatin is medically inappropriate.

TOBACCO CESSATION MEDICATION
Tobacco cessation medication (i.e., Chantix ®, bupropion, Nicotrol®, nicotine gums and nicotine patches) are covered as a preventive service for all adults who use tobacco products.

MISCELLANEOUS

IMMUNIZATIONS
In accordance with the Advisory Committee on Immunization Practices (ACIP), routine immunization recommendations, routine immunizations, and their administration are covered as a preventive service for all adults.

For the immunization’s schedule refer to medical policy 08.01.04 - Preventive Immunization.

CPT Procedure Code Number(s) and Narrative(s) 90620, 90621, 90630, 90632, 90633, 90636, 90644, 90647, 90648, 90651, 90653, 90654, 90655, 90656, 90657, 90658, 90660, 90661, 90662, 90670, 90672, 90673, 90674, 90680, 90681, 90682, 90685, 90686, 90687, 90688, 90689, 90694, 90696, 90698, 90700, 90702, 90707, 90710, 90713, 90714, 90715, 90716, 90723, 90732, 90733, 90734, 90736, 90739, 90740, 90743, 90744, 90746, 90747, 90748, 90750, 90756


IMMUNIZATION ADMINISTRATION

90460, 90461, 90471, 90472, 90473, 90474
ICD-10 Diagnosis Code Number(s) and Narrative(s) N/A
HCPCS Level II Code Number(s) and Narrative(s) Q2034 Influenza virus vaccine, split virus, for intramuscular use (Agriflu)

Q2035 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (AFLURIA)

Q2036 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (FLULAVAL)

Q2037 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (FLUVIRIN)

Q2038 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (FLUZONE)

IMMUNIZATION ADMINISTRATION

G0008 Administration of influenza virus vaccine

G0009 Administration of pneumococcal vaccine

G0010 Administration of hepatitis B vaccine

J3530 Nasal vaccine inhalation

PROLONGED PREVENTIVE SERVICES

Prolonged preventive services are covered as a preventive service in the office or other outpatient setting when billed as an add-on to an applicable preventive service.

CPT Procedure Code Number(s) and Narrative(s) N/A
ICD-10 Diagnosis Code Number(s) and Narrative(s) N/A
HCPCS Level II Code Number(s) and Narrative(s) G0513 Prolonged preventive service(s) (beyond the typical service time of the primary procedure), in the office or other outpatient setting requiring direct patient contact beyond the usual service; first 30 minutes (list separately in addition to code for preventive service)

G0514 Prolonged preventive service(s) (beyond the typical service time of the primary procedure), in the office or other outpatient setting requiring direct patient contact beyond the usual service; each additional 30 minutes (list separately in addition to code G0513 for additional 30 minutes of preventive service)

Version Effective Date: 01/01/2020
Version Issued Date: 12/31/2019
Version Reissued Date: N/A

Connect with Us        


© 2017 Independence Blue Cross.
Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania.