LIST OF ACA PREVENTIVE SERVICES AND CPT CODES

1 OF ACA PREVENTIVE SERVICES AND CPT CODES | 1 PREVENTIVE SERVICES covered under the Affordable Care ActCPT CODE(S)Suggested ICD-9 CODE(S)In order of preferenceHCPCS CODE(S)Medicare & some commercial payersFor private insurance, append Modifier 33 to SERVICES that are not inherently PREVENTIVE to indicate an ACA service , 99201-99215 CHLAMYDIA SCREENING86631 Chlamydia antibody86632 Chlamydia IGm87110 Chlamydia culture any source87270 Chlamydia antigen detection by immunofluorescent technique87320 Chlamydia antigen detection by enzyme immunoassay technique87490 Chlamydia direct probe technique87491 Chlamydia amplified probe technique87492 Chlamydia quantification87801 Infectious agent detection by DNA or RNA, direct probe technique87810 Chlamydia antigen detection by immunoassay with direct optical observation*36415 Venipuncture if performed*99000 Handling and preparation specimens if sending to an outside lab or state Screening for Screening for unspecified Chlamydial Screening for venereal Screening for unspecified infectious diseaseNoneThis is meant to be a general guide for reporting and billing PREVENTIVE SERVICES covered by the Affordable Care Act (ACA) without cost-sharing.

2 It was developed and formatted based on CPT and ICD-9 billing guidelines. Individual state Medicaid programs and private commerical insurances may have other instructions for reporting and reimbursing for these particular SERVICES . Medicare uses HCPCS CODES to describe PREVENTIVE SERVICES . NOTE: Most private payers expect that these PREVENTIVE SERVICES (counseling, screening and immunizations) occur during the annual PREVENTIVE exam and may not reimburse separately for these on the same day nor at subsequent OF ACA PREVENTIVE SERVICES AND CPT CODES *These screening labs and visits for immunizations may also be billed with PREVENTIVE medicine visits 99381, 99382, 99383, 99384, 99385, 99386, 99387 (New patients by age) / 99391, 99392, 99393, 99394, 99395, 99396, 99397(Established patients by age) as well as counseling visits (99401- 99404 by time) or problem oriented office visit CODES (99201-99215) OF ACA PREVENTIVE SERVICES AND CPT CODES | 2 PREVENTIVE SERVICES covered under the Affordable Care ActCPT CODE(S)Suggested ICD-9 CODE(S)In order of preferenceHCPCS CODE(S)

3 Medicare & some commercial payersFor private insurance, append Modifier 33 to SERVICES that are not inherently PREVENTIVE to indicate an ACA service , 99201-99215 GONORRHEA SCREENING 87590 Neisseria gonorrhea, direct probe technique87591 Neisseria gonorrhea, amplified probe technique87592 Neisseria gonorrhea, quantification87801 Infectious agent detection by DNA or RNA, direct probe technique87850 Neisseria gonorrhea antigen detection by immunoassay with direct optical observation*36415 Venipuncture if performed*99000 Handling and preparation specimens if sending to an outside lab or state Screening for venereal Screening for unspecified infectious diseaseNoneHIV SCREENING86689 HIV antibody confirmatory test ( , Western blot)86701 HIV-1 antibody86701 HIV-2 antibody86703 HIV-1 & HIV-2 antibody*36415 Venipuncture if performed*99000 Handling and preparation specimens if sending to an outside lab or state Screening for specified viral Suspected carrier of other specified Screening for venereal Screening for unspecified infectious diseaseG0432 Infectious agent antibody detection by enzyme immunoassay (eia) technique, HIV-1 and/or HIV-2, screeningG0433 Infectious agent antibody detection by enzyme-linked immunosorbent assay (elisa)

4 Technique, HIV-1 and/or HIV-2, screeningG0435 Infectious agent antibody detection by rapid antibody test, HIV-1 and/or HIV-2, screeningS3645 HIV-1 antibody testing of oral mucosal transudate*These screening labs and visits for immunizations may also be billed with PREVENTIVE medicine visits 99381, 99382, 99383, 99384, 99385, 99386, 99387 (New patients by age) / 99391, 99392, 99393, 99394, 99395, 99396, 99397(Established patients by age) as well as counseling visits (99401- 99404 by time) or problem oriented office visit CODES (99201-99215) OF ACA PREVENTIVE SERVICES AND CPT CODES | 3 PREVENTIVE SERVICES covered under the Affordable Care ActCPT CODE(S)Suggested ICD-9 CODE(S)In order of preferenceHCPCS CODE(S)Medicare & some commercial payersFor private insurance, append Modifier 33 to SERVICES that are not inherently PREVENTIVE to indicate an ACA service , 99201-99215 SYPHILIS SCREENING 86592 Syphilis test, qualitative VDRL, RPR86593 Syphilis test, quantitative VDRL, RPR*36415 Venipuncture if performed*99000 Handling and preparation specimens if sending to an outside lab or state Screening for venereal Screening for unspecified bacterial or spirochetal Screening for unspecified infectious diseaseNoneBEHAVIORAL COUNSELING TO PREVENT SEXUALLY TRANSMITTED INFECTIONS STD labs and lab collection CODES may also be billed with these counseling visits99201 New patient problem visit99205 (Document and bill based on counseling time)

5 99211 Established patient problem visit99215 (Document and bill based on counseling time)99401 PREVENTIVE medicine counseling and/or risk factor reduction: 15 mins99402 PREVENTIVE medicine counseling and/or risk factor reduction: 30 mins99403 PREVENTIVE medicine counseling and/or risk factor reduction: 45 mins99404 PREVENTIVE medicine counseling and/or risk factor reduction: 60 Encounter for counseling on other STDs* Or any ICD-9 code for STDG0445 High 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*These screening labs and visits for immunizations may also be billed with PREVENTIVE medicine visits 99381, 99382, 99383, 99384, 99385, 99386, 99387 (New patients by age) / 99391, 99392, 99393, 99394, 99395, 99396, 99397(Established patients by age) as well as counseling visits (99401- 99404 by time) or problem oriented office visit CODES (99201-99215) OF ACA PREVENTIVE SERVICES AND CPT CODES | 4 PREVENTIVE SERVICES covered under the Affordable Care ActCPT CODE(S)Suggested ICD-9 CODE(S)In order of preferenceHCPCS CODE(S)

6 Medicare & some commercial payersFor private insurance, append Modifier 33 to SERVICES that are not inherently PREVENTIVE to indicate an ACA service , 99201-99215 HPV VACCINATIONS90649 Gardasil 90650 Cervarix 90460 Administration of vaccine through age 18 with counseling by provider any route, 1st90461 Administration of vaccine through age 18 with counseling by provider any route, additional during that encounter90471 Administration of vaccine any route, 1st90472 Administration of vaccine any route, each additional during that encounterRequires a CPT code for the immunization and a CPT code for the Need for vaccination against other viral Encounter for immunizations appropriate for age - use for adolescents Routine general Routine gyn examNoneHUMAN PAPILLOMAVIRUS DNA TESTING 87620 HPV detection by DNA or RNA, direct probe technique87621 HPV detection by DNA or RNA, amplified probe technique87622 HPV Screening for Routine Routine general Routine gyn examNone*These screening labs and visits for immunizations may also be billed with PREVENTIVE medicine visits 99381, 99382, 99383, 99384, 99385, 99386, 99387 (New patients by age) / 99391, 99392, 99393, 99394, 99395, 99396, 99397(Established patients by age) as well as counseling visits (99401- 99404 by time)

7 Or problem oriented office visit CODES (99201-99215) OF ACA PREVENTIVE SERVICES AND CPT CODES | 5 PREVENTIVE SERVICES covered under the Affordable Care ActCPT CODE(S)Suggested ICD-9 CODE(S)In order of preferenceHCPCS CODE(S)Medicare & some commercial payersFor private insurance, append Modifier 33 to SERVICES that are not inherently PREVENTIVE to indicate an ACA service , 99201-99215 CONTRACEPTIVE COUNSELING99201 New patient problem visit99205 (Document and bill based on counseling time)99211 Established patient problem visit 99215 (Document and bill based on counseling time)99401 PREVENTIVE medicine counseling and/or risk factor reduction: 15 min99402 PREVENTIVE medicine counseling and/or risk factor reduction: 30 min99403 PREVENTIVE medicine counseling and/or risk factor reduction: 45 min99404 PREVENTIVE medicine counseling and/or risk factor reduction: 60 General counseling and advice: Rx oral General counseling and advice: initiation of another General counseling and instruction in natural family planning Other family planning adviceNoneWELL WOMAN VISITP reventive visits for new patients by age: 99381, 99382, 99383, 99384, 99385, 99386, 99387 PREVENTIVE visits for established patients by age: 99391, 99392, 99393, 99394, 99395, 99396, 99397 Routine general Routine gyn examG0402 Initial PREVENTIVE physical exam-ination; face-to-face visit, SERVICES limited to new beneficiary during the first 12 months of Medicare enrollmentG0438 Annual wellness visit.

8 Includes a personalized prevention plan of service (pps), initial visitG0439 Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visitS0610 Annual gynecological examina-tion, new patientS0612 Annual gynecological examina-tion, established patientS0613 Annual gynecological examina-tion; clinical breast examination without pelvic OF ACA PREVENTIVE SERVICES AND CPT CODES | 6 PREVENTIVE SERVICES covered under the Affordable Care ActCPT CODE(S)Suggested ICD-9 CODE(S)In order of preferenceHCPCS CODE(S)Medicare & some commercial payersFor private insurance, append Modifier 33 to SERVICES that are not inherently PREVENTIVE to indicate an ACA service , 99201-99215 HEPATITIS A IMMUNIZATION 90632 Hepatitis A adult dosage90633 Hepatitis A Pedi/adolescent dos-age 2 dose schedule90634 Hepatitis A Pedi/adolescent dos-age 3 dose schedule90636 Hep and Hep B adult dosage90460 Administration of vaccine through age 18 with counseling by provid-er any route, 1st90461 Administration of vaccine through age 18 with counseling by provid-er any route, additional during that encounter90471 Administration of vaccine any route, 1st90472 Administration of vaccine any route.

9 Each additional during that encounterRequires a CPT code for the immunization and a CPT code for the Need for vaccination against other viral Encounter for immunizations appropriate for age use for adolescents Routine general Routine gyn examNone*These screening labs and visits for immunizations may also be billed with PREVENTIVE medicine visits 99381, 99382, 99383, 99384, 99385, 99386, 99387 (New patients by age) / 99391, 99392, 99393, 99394, 99395, 99396, 99397(Established patients by age) as well as counseling visits (99401- 99404 by time) or problem oriented office visit CODES (99201-99215) OF ACA PREVENTIVE SERVICES AND CPT CODES | 7 PREVENTIVE SERVICES covered under the Affordable Care ActCPT CODE(S)Suggested ICD-9 CODE(S)In order of preferenceHCPCS CODE(S)Medicare & some commercial payersFor private insurance, append Modifier 33 to SERVICES that are not inherently PREVENTIVE to indicate an ACA service , 99201-99215 HEPATITIS B IMMUNIZATION 90636 Hep and Hep B adult dosage90739 Hepatitis B adult dosage 2 dose schedule90740 Hepatitis B for immunosup-pressed 3 dose schedule90743 Hepatitis B Adolescent dosage 2 dose schedule90744 Hepatitis A Pedi/adolescent dosage 3 dose schedule90746 Hepatitis B adult dosage 2 dose schedule90747 Hepatitis B for immunosup-pressed 4 dose schedule90460 Administration of vaccine through age 18 with counseling by provid-er any route, 1st90461 Administration of vaccine through age 18 with counseling by provid-er any route, additional during that encounter90471 Administration of vaccine any route.

10 1st90472 Administration of vaccine any route, each additional during that encounterRequires a CPT code for the immunization and a CPT code for the Need for vaccination against other viral Encounter for immunizations appropriate for age use for adolescents Routine general Routine gyn examG0010 Administration of Hepatitis B vaccineSTDTAC/Jan. 2014. Thank you to Lissa Singer, RNP, MB, CPC-I, for her contributions to this OF ACA PREVENTIVE SERVICES AND CPT CODES | 8 PREVENTIVE SERVICES covered under the Affordable Care ActCPT CODE(S)Suggested ICD-9 CODE(S)In or