Preventive Medicine Services with Screening and other Evaluation and Management Services
Defines Anthem Blue Cross and Blue Shield's reimbursement position when preventive medicine services (CPT 99381-99397, 99391-99397, HCPCS G0402) are billed the same day as other specific E/M, screening, counseling, nutrition, prolonged, visual, or annual gynecologic services; affects professional providers submitting commercial claims.
Updated title from Screening Services with Related Evaluation & Management Services and added specific categories that are not separately reimbursable; updated Related Coding section to include nonreimbursable codes.
Added language noting that annual GYN examinations (S0610, S0612, S0613) are included in reimbursement for preventive medicine services and not eligible for separate reimbursement.
Updated Related Coding section to list specific codes (e.g., G0101-G0102, Q0091, 97802-97804, etc.) that are not eligible for separate reimbursement when billed with preventive or certain E/M services.
Same-day Preventive and Related Services Coverage Rules
Coverage rules for same-day preventive and related services
When a preventive medicine service (CPT 99381-99387, 99391-99397, HCPCS G0402) is billed on the same day by the same provider with certain other services, only the preventive medicine service is eligible for reimbursement unless overridden by provider, state, or federal contracts or requirements.
ALL of the following
- Preventive medicine code present (CPT 99381-99387, 99391-99397, or HCPCS G0402)
AND any of the following services billed same day by same provider
- Annual gynecological examinations (S0610, S0612, S0613) - not eligible for separate reimbursement
- Counseling services (0403T, 99401-99404, 99406-99409, 99411-99412, G0296, G0396-G0397, G0443, G0445-G0447, G0473, H0005, S0257, S0265, S9470, T1006, T1027) - not eligible for separate reimbursement