CurrentHealthChoice of OklahomaPolicy N/A

Preventive Services

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Defines HealthChoice of Oklahoma coverage rules for preventive services and screenings (e.g., routine exams, vaccines, well-child care) and explains when services are considered preventive versus diagnostic; applies to members receiving care from participating network providers.

Policy Summary

PayerHealthChoice of Oklahoma

PolicyPreventive Services

Policy CodePolicy N/A

Change TypeNo material change

Effective DateJul 1, 2026

Last ReviewNov 20, 2025

Next Review DateN/A

Key ActionWhen billing chlamydia screening include a pregnancy diagnosis code or one of the listed screening diagnosis codes and bill blood draw codes 36415/36416 only with lab codes 86631/86632 as required.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

100%preventive care covered at allowable amounts when rendered by a participating network provider

USPSTF A/BUSPSTF A/B guidance referenced

Pregnancy DX requiredPregnancy diagnosis requirement for some screenings

≈20Chlamydia/gonorrhea procedure codes listed

36415,36416Blood draw CPTs explicitly listed

Coverage Criteria

General preventive coverage criteria

Covered when ALL of the following are met

Preventive visit coverage: Service is preventive (no prior abnormality or symptoms, or prior screening was normal and follow-up is per recommended intervals)

As defined in policy text

Provider: Rendered by a participating network provider

Preventive care covered at 100% of allowable amounts when rendered by participating providers

Guideline alignment: Service aligns with USPSTF A/B, ACIP, HRSA or Bright Futures recommendations as applicable

Document references these guideline sources as defining preventive services

AAA screening

Covered when ALL of the following are met

Population: Male aged 65 through 75 years (ends on 76th birthday)age 65-75

Per USPSTF recommendation cited in row

Smoking history: Has ever smokedhistory of smoking required

Policy row references diagnosis codes indicating tobacco use/history

Procedure code: Ultrasound CPT 76706 documentedCPT 76706

Table lists 76706 for AAA screening

Bacteriuria screening in pregnancy

Covered when ALL of the following are met

Population: Pregnant personpregnancy diagnosis code present

Table rows require a pregnancy diagnosis code for coverage

Procedure codes: Urine culture/testing CPT codes (81007, 87086, 87088) as listedCPT 81007/87086/87088

Policy lists these procedure codes for bacteriuria screening

Chlamydia screening

Covered when ANY of the following population criteria are met (AND test coded as listed)

Population: Sexually active women age <=24 OR other sexually active women at increased riskage <=24 or other risk

Reflects USPSTF recommendation cited in table

Test codes: One of the listed chlamydia procedure codes billed (e.g., 86631, 86632, 87110, 87270, 87320, 87490-87494, 87801, 87810)listed CPT/HCPCS/lab codes

Rows require these procedure codes

Pregnancy option: Alternatively requires a pregnancy diagnosis code for pregnancy-specific screeningpregnancy diagnosis present

Table indicates pregnancy diagnosis allows coverage

Chlamydia screening (preventive)

Covered preventive screenings when applicable USPSTF recommendations and diagnosis codes are present

Chlamydia screening preventive coverage: Screening for chlamydia per USPSTF B recommendation in all sexually active women 24 years or younger and in women 25 years or older at increased riskage <=24 or increased risk if >=25

Requires appropriate screening or pregnancy diagnosis code on claim

Asymptomatic bacteriuria screening (pregnancy)

Covered preventive screenings when USPSTF A recommendation applies

Asymptomatic bacteriuria screening in pregnancy: Screening for asymptomatic bacteriuria using urine culture in pregnant persons per USPSTF A recommendationpregnancy diagnosis code present

Urine culture codes listed; some procedure codes may not be payable in all cases

Preventive coverage conditions

Covered when the following billing/diagnosis conditions are met:

Billing requirements: Claim includes a Pregnancy Diagnosis Code OR one of the screening diagnosis codes listed in this row, AND when lab code 86631 or 86632 is billed, an accompanying blood draw code 36415 or 36416 must be billed.

Blood draw codes only apply to lab codes 86631 or 86632; claims lacking required diagnosis or blood draw coding may not qualify for the preventive benefit.

Preventive screening coverage criteria

Covered when ALL of the following are met:

Billing linkage: The blood draw code (36415 or 36416) must be billed with lab code 86631 or 86632 when applicable.

Blood draw codes only apply to lab codes 86631 or 86632.

Diagnosis requirement: A Pregnancy diagnosis code OR one of the screening diagnosis codes listed in the policy row must be submitted with the chlamydia screening claim.

Applies specifically for pregnant persons and related rows in the document.

Population guidance: Screening is recommended per USPSTF for sexually active women 24 years or younger and for women 25 years or older who are at increased risk; document also references sexually active adolescents and adults more generally.

USPSTF Rating B cited (Sept 2021).

Covered with billing/diagnosis criteria

Covered when ALL of the following billing conditions are met:

Billing and diagnosis requirements: Provider must bill an approved chlamydia screening procedure/lab code (examples include 86631, 86632, 87110, 87270, 87320, 87490, 87491, 87492, 87494, 87801, 87810).

Codes listed across chunks 72-76

Blood draw linkage: If billing blood draw codes 36415 or 36416, they must be billed only with lab codes 86631 or 86632 and include either one of the screening diagnosis codes listed or a pregnancy diagnosis code.

Document repeatedly states this requirement (chunks 72-76)

Appropriate diagnosis: A screening diagnosis code from the listed screening row (e.g., preventive visit codes Z00.00, Z00.01 for adults or Z00.121, Z00.129 for children) or a pregnancy diagnosis code must be present on the claim.

Chunks 86-91

Preventive chlamydia screening coverage

Covered when screening aligns with USPSTF/Bright Futures recommendations and appropriate coding/billing is used

Primary coverage criteria: 1) Patient is a sexually active female (adolescent or adult); 2) Age <=24 years OR age >=25 with increased risk for chlamydia; 3) For pregnant persons, screening performed as part of pregnancy care; 4) Billing includes an acceptable chlamydia screening procedure code (e.g., 86631, 86632, 87110, 87270, 87320, 87490-87494, 87801, 87810) and an appropriate diagnosis code (either a pregnancy diagnosis code when pregnant or one of the listed screening/encounter diagnosis codes); 5) If lab codes 86631 or 86632 are billed, blood draw code 36415 or 36416 must be billed with them as required by the document.

Follows USPSTF (Sept 2021) and Bright Futures guidance as cited.

Preventive coverage criteria

Covered when ALL of the following are met

Basic coverage conditions: 1) Procedure billed is one of the listed chlamydia screening lab codes (86631, 86632, 87110, 87270, 87320, 87490, 87491, 87492, 87494, 87801, 87810). 2) A pregnancy diagnosis code OR one of the listed screening diagnosis codes must be present on the claim.

Blood draw codes (36415, 36416) are allowed only when billed with lab codes 86631 or 86632 and accompanied by the required diagnosis code(s).

Preventive Screening Coverage Conditions

Covered when billing meets diagnostic and coding requirements:

Billing requirements: Claim includes one of the listed screening procedure codes (86631, 86632, 87110, 87270, 87320, 87490, 87491, 87492, 87494, 87801, 87810).

Procedure codes listed across multiple chunks.

Diagnosis requirement: When blood draw codes (36415 or 36416) are billed with lab codes 86631 or 86632, the claim must include either a pregnancy diagnosis code OR one of the listed screening diagnosis codes (Z00.00, Z00.01, Z00.121, Z00.129, Z11.3, Z11.4, Z11.8, Z11.9, Z20.2, Z20.6, Z29.81, Z72.51, Z72.52, Z72.53).

Explicit requirement repeated in multiple chunks.

Preventive Screening — Coverage Criteria

Covered when documentation supports screening per USPSTF/Bright Futures guidance and billing rules are followed

Preventive screening coverage conditions: Screening is covered when: (1) the patient falls within the USPSTF/Bright Futures target population (sexually active adolescents/adult women; USPSTF: women <=24 years or older if increased risk; Bright Futures: risk-based ages 11–21 years), AND (2) appropriate screening procedure codes (examples: 86631, 86632, 87491, 87492, 87494, 87801, 87810, 87590-92, 87850) are used, AND (3) if blood draw codes 36415/36416 are billed they must be billed with 86631/86632 and with one of the listed screening diagnosis codes or a pregnancy diagnosis code.

This chunk-level criteria reflects instructions present in the file; the document indicates some codes 'may not be payable in all' circumstances.

Preventive Screening Coverage Criteria

Covered when ALL of the following are met

Lab/blood-draw linkage: When blood draw CPTs 36415 or 36416 are billed they must be submitted with lab test code 86631 or 86632 and with one of the screening diagnosis codes listed (e.g., Z00.00, Z11.3) or a pregnancy diagnosis code.

Support: chunks 162,166

Target population: Screening applies to sexually active adolescents and adult women; USPSTF recommends screening all sexually active women 24 or younger and older women at increased risk; Bright Futures recommends risk-based STI screening in adolescents (approx. ages 11-21).

Support: chunks 162,163,167

Chlamydia screening — Covered criteria

Covered when ALL of the following apply

USPSTF recommendation logic: Screening for chlamydia is recommended for all sexually active women 24 years or younger; screening is recommended in women 25 years or older when at increased risk. Recommendations apply to adolescents and adult women including pregnant women. Bright Futures advises STI screening when risk assessment is positive between ages 11-21 years.age and risk-based

Applies to chlamydia; gonorrhea screening procedure codes are listed alongside chlamydia codes; blood draw codes apply when used with specified lab codes.

Chlamydia screening — USPSTF recommendation

Covered when USPSTF recommends screening for the population below:

Population who should be screened: Sexually active women 24 years or youngerage <= 24

Includes adolescents and pregnant women as stated

Older women screening indication: Women 25 years or older who are at increased risk for infectionage >= 25 AND risk factors present

Risk assessment per Bright Futures recommended between ages 11-21 for adolescents; specific risk factors not listed in this excerpt

Preventive screening criteria

Covered when any of the following apply

All sexually active women <=24: Screening is recommended for all sexually active women 24 years or younger.age <= 24 years

Applies to adolescents, adults, and pregnant women

Women 25+ at increased risk: Screening is recommended for women 25 years or older who are at increased risk for chlamydia infection.age >= 25 with increased risk

'Increased risk' not defined in this excerpt

Bright Futures recommendation: Bright Futures recommends STI screening if risk assessment is positive between ages 11-21.age 11-21 with positive risk assessment

Supplementary guidance for adolescents

Chlamydia screening (USPSTF)

Covered when the USPSTF recommendations are met:

Chlamydia screening criteria: ALL of the following: patient is a sexually active woman aged 24 years or younger; or patient is a sexually active woman aged 25 years or older AND at increased risk for infection; recommendation applies to pregnant women as well.age and risk

Bright Futures also recommends screening for adolescents 11-21 years if risk assessment is positive.

Gonorrhea screening (USPSTF)

Covered when the USPSTF recommendation for gonorrhea screening is met:

Gonorrhea screening criteria: USPSTF recommends screening for gonorrhea in all sexually active individuals where applicable; apply same age/risk considerations as chlamydia per USPSTF guidance.USPSTF B recommendation

Document references USPSTF rating B (Sept 2021).

Preventive screening recommendations (USPSTF)

Covered when the following USPSTF and Bright Futures recommendations apply:

Gonorrhea screening: USPSTF recommends screening for gonorrhea in all sexually active individuals where applicable; applies to sexually active adolescents and adult women, including pregnant women.USPSTF B

Bright Futures recommends STI screening if risk assessment is positive between ages 11-21.

Chlamydia screening: USPSTF recommends chlamydia screening in all sexually active women 24 years or younger and in women 25 years or older who are at increased risk for infection.age <=24 or age >=25 with increased risk

Recommendation applies to pregnant women as well.

Services delivered during a preventive care visit that are not qualifying preventive services (for example, evaluation or management for new symptoms, workup of an abnormal result, or other diagnostic testing) are not paid as part of the preventive benefit and may be subject to member cost‑sharing. The policy distinguishes preventive from diagnostic services: preventive services apply to persons without symptoms or prior abnormal findings or when prior screening was normal and the next screen is at the recommended interval, whereas diagnostic services are those performed after an abnormality, when symptoms exist, or when repeat testing is done at shortened intervals and are covered under standard plan benefits.

Certain procedure codes listed in the preventive table (for example, 81007, 87086, 87088) carry a payability caveat in the document. Providers should verify payment eligibility before billing these specific procedure codes because the policy notes that some codes "may not be payable in all" circumstances.

The policy repeatedly cautions that some codes "may not be payable in all" circumstances. This general payability caveat applies across multiple screening rows; when selecting procedure codes, providers should confirm coverage and any applicable program-specific rules that could affect payment.

For chlamydia/gonorrhea and related laboratory entries the file emphasizes billing conditions that affect payability. Blood draw CPTs (e.g., 36415, 36416) only apply when billed with specific lab codes (notably 86631 or 86632); failure to meet these pairings or associated diagnosis requirements may render the codes non‑payable.

The preventive benefit instructions require that when blood draw CPTs are billed they must be accompanied by the specified laboratory test codes and an appropriate diagnosis (either a pregnancy diagnosis code for pregnant members or one of the listed screening diagnosis codes). If these linkages are not present, the policy indicates the codes "may not be payable in all" situations.

Multiple rows include the standardized note that "Certain codes may not be payable in all" situations without listing every combination. This means providers should not assume universal payability for every code shown; verify that the billed code is payable under the member’s plan and that required diagnosis and code pairings are present.

Across the STI screening entries the document flags a broad payability caveat: some procedure codes may be excluded or denied depending on context (code selection, accompanying diagnosis, or missing required linkages). Providers should review the member’s benefits and any related guidance before submitting claims.

The policy includes recurring payability cautions stating certain codes "may not be payable in all circumstances." This general advisory reinforces that claim-level details (diagnosis, specimen source, and appropriate lab/collection pairings) determine whether a code will be paid as a preventive service.

Several procedure groups (including chlamydia/gonorrhea NAATs and related lab codes) are listed as covered when billed per instructions, but the document also notes that specific codes "may not be payable in all" circumstances. Confirm code payability for the member and ensure required diagnosis and blood‑draw pairings are present to reduce the risk of denials.

The preventive service tables include generic payability warnings: specific codes may be subject to other policies, coverage limits, or certification requirements and therefore "may not be payable in all situations." Providers should check for program or plan restrictions before billing.

Where the policy lists multiple acceptable chlamydia screening codes it also repeats that some codes "may not be payable in all contexts." That emphasizes the need to follow the stated billing rules (required diagnosis codes, and blood‑draw/linkage rules for lab codes) to qualify for preventive coverage.

Notes in the document caution that certain listed procedure codes are not universally payable; providers must confirm coverage applicability and any necessary certification or documentation prior to claim submission.

The policy repeatedly highlights that blood draw CPTs (36415, 36416) only apply when billed with specific lab test codes (notably 86631 or 86632). Omitting the required lab code or diagnosis can lead to non‑payment of those collection codes.

Where the table rows instruct that a Pregnancy Diagnosis Code OR one of the listed screening diagnosis codes must be present, the document also appends the general caveat that some procedure codes "may not be payable in all" circumstances. This reinforces that correct diagnosis coding is essential to receive preventive benefit payment.

When symptoms are present or when testing is done to evaluate a previously abnormal finding, those services are considered diagnostic rather than preventive and are not adjudicated under the preventive benefit. The policy distinguishes diagnostic services (performed for abnormal results, symptoms, or shortened‑interval repeats) from preventive services and indicates diagnostic services fall under standard plan benefits.

No explicit statements in the cited entries label any of the listed services as universally "not medically necessary." Instead, the document frames exclusions and payability in terms of coverage rules, required diagnosis linkages, and context‑dependent payment restrictions rather than blanket medical‑necessity denials.

The reviewed chunks do not contain a general 'not medically necessary' declaration for the screening services; rather the policy uses conditional language about payability and required billing/diagnosis pairings to determine whether a service will be paid under the preventive benefit.

Coding

Abdominal Aortic Aneurysm screening CPTCPTCovered

76706

Ultrasound Screening Study for Abdominal Aortic Aneurysm

Bacteriuria and pregnancy-related urine testingCPTCovered

81007	Urinalysis, non-automated
87086	Urine culture
87088	Urine culture with organism identification

Chlamydia infection screening CPT/assay codesCPTCovered

86631	Chlamydia antigens
86632	Chlamydia antigens (alternate)
87110	Culture for chlamydia
87270	Chlamydia culture (cell culture)
87320	Chlamydia NAAT or antigen
87490	Chlamydia NAAT - unlisted
87491	Chlamydia NAAT - single target
87492	Chlamydia NAAT - multiple targets
87494	Chlamydia/GC multiplex NAAT
87801	Chlamydia direct probe

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Diagnosis codes referenced in table rowsICD-10

F17.210	Nicotine dependence, cigarettes, uncomplicated
F17.211	Nicotine dependence, cigarettes, in remission
F17.213	Nicotine dependence, cigarettes with withdrawal
F17.218	Other nicotine dependence
F17.219	Nicotine dependence, unspecified
Z87.891	Personal history of nicotine dependence

Pregnancy-related diagnosis requirementICD-10

Pregnancy Diagnosis Codes

Various ICD-10 pregnancy diagnosis codes referenced for pregnancy-specific screenings

Chlamydia Infection Screening CPT/HCPCS/Lab CodesmixedCovered

86631	Chlamydia infection screening (lab code) (as listed)
86632	Chlamydia infection screening (lab code) (as listed)
87110	Culture, chlamydia (as listed)
87270	Chlamydia test (as listed)
87320	Chlamydia test (as listed)
87490	Chlamydia test (as listed)
87491	Chlamydia NAAT (as listed)
87492	Chlamydia NAAT (as listed)
87494	Chlamydia test (as listed)
87801	Chlamydia antigen test (as listed)

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Blood draw codesCPT

36415	Collection of venous blood by venipuncture (blood draw)
36416	Collection of capillary blood specimen (blood draw)

Urine culture / related procedure codes (payment may vary)CPT

81007	Urinalysis (may not be payable in all cases)
87086	Culture, bacterial; quantitative colony count (as listed)
87088	Urine culture, colony count (as listed)

Covered lab/procedure codes for chlamydia screeningCPT|HCPCSCovered

86631	Chlamydia infection screening (laboratory)
86632	Chlamydia infection screening (laboratory)
87110	Culture, chlamydia
87270	Chlamydia NAAT/other
87320	Trichomonas/other protozoa testing (listed here)
87490	Chlamydia NAAT, unspecified specimen
87491	Chlamydia NAAT, pelvic swab
87492	Chlamydia NAAT, urethral swab
87494	Chlamydia NAAT, other
87801	Chlamydia diagnostic test

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Blood draw codes (required with certain lab codes)CPTCovered

36415	Collection of venous blood by venipuncture
36416	Collection of capillary blood sample

Urine culture/related procedure codes referencedCPTCovered

81007	Urinalysis, by dipstick
87086	Urine culture with isolation
87088	Urine culture with colony count

Chlamydia Infection Screening CPT/CLIA CodesCPTCovered

86631	Chlamydia infection screening (lab code) from document
86632	Chlamydia infection screening (lab code) from document
87110	Chlamydia Infection Screening (procedure code) from document
87270	Chlamydia Infection Screening (procedure code) from document
87320	Chlamydia Infection Screening (procedure code) from document
87490	Chlamydia Infection Screening (procedure code) from document
87491	Chlamydia Infection Screening (procedure code) from document
87492	Chlamydia Infection Screening (procedure code) from document
87494	Chlamydia Infection Screening (procedure code) from document
87801	Chlamydia Infection Screening (procedure code) from document

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Blood draw codes (only apply with specific lab codes)CPT

36415	Collection of venous blood by venipuncture (blood draw) — applicable when billed with 86631 or 86632
36416	Collection of capillary blood — applicable when billed with 86631 or 86632

Chlamydia Infection Screening CPT/LOINC/etcmixedCovered

86631	Chlamydia Infection Screening (lab code) listed
86632	Chlamydia Infection Screening (lab code) listed
87110	Chlamydia Infection Screening (procedure code)
87270	Chlamydia Infection Screening (procedure code)
87320	Chlamydia Infection Screening (procedure code)
87490	Chlamydia Infection Screening (procedure code)
87491	Chlamydia Infection Screening (procedure code)
87492	Chlamydia Infection Screening (procedure code)
87494	Chlamydia Infection Screening (procedure code)
87801	Chlamydia Infection Screening (procedure code)

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Blood draw codes (only applicable with lab codes 86631/86632)CPTCovered

36415	Blood draw
36416	Blood draw

Diagnosis codes (preventive visit / screening / pregnancy)ICD-10

Z00.00	Adult preventive encounter
Z00.01	Adult preventive encounter with findings
Z00.121	Child preventive visit (with or without newborn)
Z00.129	Child preventive visit (unspecified)

Pregnancy diagnosis codesICD-10

Pregnancy Diagnosis Code

Generic reference to pregnancy diagnosis codes required when applicable

Chlamydia Infection Screening (procedure CPT/HCPCS)CPTCovered

86631	Chlamydia infection screening (laboratory) - listed
86632	Chlamydia infection screening (laboratory) - listed
87110	Culture identification, chlamydia - listed
87270	Direct fluorescent antibody - listed
87320	Chlamydia trachomatis detection - listed
87490	Infectious agent detection by nucleic acid (chlamydia) - listed
87491	Chlamydia NAT, amplified probe - listed
87492	Chlamydia NAT, direct probe - listed
87494	Chlamydia detection by probe technique - listed
87801	Antigen detection (chlamydia) - listed

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Blood draw CPTs (apply when billing 86631 or 86632)CPTCovered

36415	Collection of venous blood by venipuncture
36416	Collection of capillary blood specimen (e.g., finger, heel)

Diagnosis / Screening encounter codesICD-10

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
Z11.4	Encounter for screening for other infectious and parasitic diseases
Z11.8	Encounter for screening for other infectious and parasitic diseases (other)
Z11.9	Encounter for screening, unspecified
Z20.2	Contact with and (suspected) exposure to infections with a predominantly sexual mode of transmission
Z20.6	Contact with and (suspected) exposure to other communicable diseases

Pregnancy diagnosis (generic)ICD-10

Pregnancy Diagnosis Code

Documented pregnancy diagnosis code required when screening pregnant persons (exact pregnancy codes referenced generically in document)

Covered laboratory / screening CPT/HCPCS codesmixedCovered

86631	Chlamydia Infection Screening
86632	Chlamydia Infection Screening
87110	Chlamydia Infection Screening
87270	Chlamydia Infection Screening
87320	Chlamydia Infection Screening
87490	Chlamydia Infection Screening
87491	Chlamydia Infection Screening
87492	Chlamydia Infection Screening
87494	Chlamydia Infection Screening
87801	Chlamydia Infection Screening

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Blood draw CPT codes (allowed only with specific lab codes)CPTCovered

36415	Venipuncture (blood draw)
36416	Collection of capillary blood specimen (blood draw)

Allowed screening and related diagnosis codesICD-10

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
Z11.4	Encounter for screening for other infectious and parasitic diseases
Z11.8	Encounter for screening for other infectious and parasitic diseases
Z11.9	Encounter for screening, unspecified
Z20.2	Contact with and (suspected) exposure to infections with a predominantly sexual mode of transmission
Z20.6	Contact with and (suspected) exposure to viral hepatitis

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Chlamydia Infection Screening Procedure CodesCPTCovered

86631	Chlamydia infection screening (serology) - listed
86632	Chlamydia infection screening (serology) - listed
87110	Culture
87270	Wet mount/other microscopy
87320	Chlamydia antigen detection
87490	Chlamydia NAAT
87491	Chlamydia NAAT
87492	Chlamydia NAAT
87494	Chlamydia/gonorrhea combo NAAT
87801	Infectious agent detection

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Blood Draw Codes (must accompany specific lab codes)CPTCovered

36415	Collection of venous blood by venipuncture
36416	Collection of capillary blood

Applicable Screening & Pregnancy Diagnosis CodesICD-10

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
Z11.4	Encounter for screening for viral diseases
Z11.8	Encounter for screening for other infectious and parasitic diseases
Z11.9	Encounter for screening, unspecified
Z20.2	Contact with and (suspected) exposure to infections with a predominantly sexual mode of transmission
Z20.6	Contact with and (suspected) exposure to HIV

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Chlamydia and Gonorrhea Screening / Blood drawCPTCovered

86631	Chlamydia/C. trachomatis test (document lists as chlamydia infection screening)
86632	Companion chlamydia test code (document lists as chlamydia infection screening)
87110	Microbial culture (code listed in screening set)
87270	Aerobic bacterial smear/culture code (listed)
87320	Chlamydia trachomatis antigen detection (listed)
87490	Chlamydia NAAT (listed)
87491	Chlamydia NAAT genital (listed)
87492	Chlamydia NAAT non-genital (listed)
87494	Chlamydia test code (listed)
87801	Gonorrhea/chlamydia test (listed)

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Screening/diagnosis codesICD-10

Z00.00	Screening – general adult (listed as screening diagnosis)
Z00.01	Screening – general adult with abnormal findings (listed)
Z00.121	Child health exam without abnormal findings (listed)
Z00.129	Child health exam unspecified (listed)
Z11.3	Encounter for screening for hepatitis (listed among screening codes)
Z11.4	Encounter for screening for infections with a predominantly sexual mode of transmission (listed)
Z11.8	Encounter for other infectious and parasitic disease screening (listed)
Z11.9	Encounter for screening, unspecified (listed)
Z20.2	Contact with and (suspected) exposure to infections with predominantly sexual transmission (listed)
Z20.6	Contact with and (suspected) exposure to HIV (listed)

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Covered CPT/HCPCS codes for chlamydia/gonorrhea screening and blood drawmixedCovered

86631	Chlamydia trachomatis antigen detection (lab code listed)
86632	Chlamydia trachomatis antigen detection (lab code listed)
87110	Culture, chlamydia/gonorrhea (procedure code listed)
87270	Cell culture identification (procedure code listed)
87320	Chlamydia assay (procedure code listed)
87490	Infectious agent detection by nucleic acid (listed)
87491	Infectious agent detection by nucleic acid (listed)
87492	Infectious agent detection by nucleic acid (listed)
87494	Infectious agent detection by nucleic acid (listed)
87801	Antigen detection test (listed)

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Permissible screening/diagnosis ICD-10 codes for preventive screeningmixed

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
Z11.4	Encounter for screening for viral diseases
Z11.8	Encounter for other infectious and parasitic diseases
Z11.9	Encounter for screening, unspecified
Z20.2	Contact with and (suspected) exposure to infections with predominantly sexual transmission
Z20.6	Contact with and (suspected) exposure to HIV

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Chlamydia-related lab/test codesmixedCovered

87491	87491 (screening test code cited)
87492	87492 (screening test code cited)
87494	87494 (screening test code cited)
87801	87801 (screening test code cited)
87810	87810 (screening test code cited)
86631	Chlamydia antigen/antibody lab code
86632	Chlamydia antigen/antibody lab code
87110	Culture/microbiology code cited
87270	Microbiology culture/stain code cited
87320	Test code cited

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Gonorrhea Screening Procedure CodesCPTCovered

87590	Gonorrhea screening procedure code
87591	Gonorrhea screening procedure code
87592	Gonorrhea screening procedure code
87850	Gonorrhea screening procedure code

Blood draw codesCPT

36415	Collection of venous blood by venipuncture (blood draw)
36416	Collection of capillary blood (blood draw)

Diagnosis / encounter codesICD-10

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
Z11.4	Encounter for screening for viral diseases
Z11.8	Encounter for screening for other specified infectious and parasitic diseases
Z11.9	Encounter for screening, unspecified
Z20.2	Contact with and (suspected) exposure to infections with a predominantly sexual mode of transmission
Z20.6	Contact with and (suspected) exposure to viral hepatitis

1–10 of 14

1/2

Gonorrhea / NAAT procedure codes repeatedCPTCovered

87590	Gonorrhea Screening Procedure Code (document lists)
87591	Gonorrhea Screening Procedure Code (document lists)
87592	Gonorrhea Screening Procedure Code (document lists)
87801	Gonorrhea Screening Procedure Code (document lists)
87850	Gonorrhea Screening Procedure Code (document lists)

Additional chlamydia/gonorrhea procedure codesCPTCovered

87491	Chlamydia/Gonorrhea amplification test (document lists)
87492	Chlamydia/Gonorrhea amplification test (document lists)
87494	Chlamydia/Gonorrhea related procedure code (document lists)
87810	Additional STI test procedure code referenced

Blood draw codesCPT

36415	Blood draw (venipuncture)
36416	Blood draw (capillary or other) — listed as blood draw codes

Lab (serology) codesCPT

86631	Serologic test lab code referenced (blood draw codes only apply to lab codes 86631 or 86632)
86632	Serologic test lab code referenced (blood draw codes only apply to lab codes 86631 or 86632)

Diagnosis / screening encounter codesICD-10

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
Z11.4	Encounter for screening for other infectious and parasitic diseases
Z11.8	Encounter for screening for other specified infectious and parasitic diseases
Z11.9	Encounter for screening, unspecified
Z20.2	Contact with and (suspected) exposure to infections with a predominantly sexual mode of transmission
Z20.6	Contact with and (suspected) exposure to viral hepatitis

1–10 of 14

1/2

Chlamydia testing CPT/HCPCS codesmixedCovered

87491	Chlamydia NAAT (document lists 87491 as a testing code)
87492	Chlamydia NAAT (document lists 87492 as a testing code)
87494	Chlamydia/GC test (listed among testing codes)

Gonorrhea testing CPT/HCPCS codesmixedCovered

87590	Gonorrhea test (document lists 87590)
87591	Gonorrhea test (document lists 87591)
87592	Gonorrhea test (document lists 87592)
87801	Gonorrhea/chlamydia test (listed)
87810	Listed in places among procedure codes (appears related to GC testing)
87850	Gonorrhea testing code (listed)

Blood draw codesCPT

36415	Collection of blood by venipuncture (blood draw)
36416	Collection of blood venous (second code listed)

Lab (microscopy/serology) codes referenced for blood drawCPT

86631	Chlamydia serology/lab code (blood draw codes only apply to lab codes 86631 or 86632)
86632	Chlamydia serology/lab code (paired with blood draw codes)

Diagnosis and screening encounter codesICD-10

Z00.00	General adult health examination without abnormal findings
Z00.01	General adult health 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
Z11.4	Encounter for screening for bacterial diseases
Z11.8	Encounter for screening for other infectious and parasitic diseases
Z11.9	Encounter for screening, unspecified
Z20.2	Contact with and (suspected) exposure to infections with a predominantly sexual mode of transmission
Z20.6	Contact with and (suspected) exposure to viral hepatitis

1–10 of 14

1/2

Procedure Codes (screening tests)CPTCovered

87590	Chlamydia/Gonorrhea testing (document lists as Procedure Code)
87591	Chlamydia/Gonorrhea testing (document lists as Procedure Code)
87592	Chlamydia/Gonorrhea testing (document lists as Procedure Code)
87801	Chlamydia/Gonorrhea testing (document lists as Procedure Code)
87850	Chlamydia/Gonorrhea testing (document lists as Procedure Code)

Additional laboratory procedure codes referencedCPTCovered

87491	Test code listed in document (context: STI screening)
87492	Test code listed in document (context: STI screening)
87494	Test code listed in document (context: STI screening)

Blood draw CPT codesCPT

36415	Collection of venous blood by venipuncture
36416	Collection of capillary blood specimen (e.g., finger, heel)

Laboratory (test) codes referenced for blood draw applicabilityCPT

86631	Serology/lab code referenced as applicable with blood draw
86632	Serology/lab code referenced as applicable with blood draw

Diagnosis Codes (screening / pregnancy / exposure / risk behavior)ICD-10

Z00.00	General adult health examination without abnormal findings (screening) - listed
Z00.01	General adult health exam with abnormal findings - listed as screening example
Z00.121	Encounter for routine child health exam with abnormal findings (listed)
Z00.129	Encounter for routine child health examination without abnormal findings (listed)
Z11.3	Encounter for screening for infections with a predominantly sexual mode of transmission
Z11.4	Encounter for screening for other infectious and parasitic diseases
Z11.8	Encounter for screening for other specified infectious and parasitic diseases
Z11.9	Encounter for screening, unspecified
Z20.2	Contact with and (suspected) exposure to chlamydia
Z20.6	Contact with and (suspected) exposure to viral hepatitis

1–10 of 14

1/2

Gonorrhea screening procedure codesCPTCovered

87590	Infectious agent detection by nucleic acid (document lists as gonorrhea screening procedure code)
87591	Infectious agent detection by nucleic acid
87592	Infectious agent detection by nucleic acid
87801	Infectious agent antigen detection; gonorrhea (document lists as screening code)
87850	Infectious agent antigen detection; gonorrhea (alternate listed code)

Chlamydia screening procedure codes (additional listed)CPTCovered

87491	Infectious agent detection by nucleic acid; chlamydia (listed)
87492	Infectious agent detection by nucleic acid; chlamydia
87494	Infectious agent detection; chlamydia (listed)

Blood draw codesCPT

36415	Collection of venous blood by venipuncture
36416	Collection of capillary blood (blood draw codes referenced for lab collection)

Screening diagnosis codesICD-10

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
Z11.4	Encounter for screening for HIV
Z11.8	Encounter for screening for other infectious and parasitic diseases
Z11.9	Encounter for screening, unspecified
Z20.2	Contact with and (suspected) exposure to infections with predominantly sexual transmission
Z20.6	Contact with and (suspected) exposure to HIV

1–10 of 14

1/2

inv-93: AAA screening age — one-time for men aged 65-75 years

Age rangeOne-time screening for men aged 65 through 75 years (ends on 76th birthday)

FrequencyOne-time (single screening per USPSTF recommendation)

Procedure codeUltrasound screening study for AAA — CPT 76706

Smoking history requirementRecommendation applies to men who have ever smoked

Supporting guidanceUSPSTF recommendation cited (December 2019) in policy row

inv-94: Age threshold for routine chlamydia screening — ≤ 24 years (screen all sexually active women)

Age thresholdScreen all sexually active women age 24 years or younger

Older womenWomen aged 25 years or older screened only if at increased risk

PopulationApplies to sexually active adolescents and adult women, including pregnant women

Supporting codesChlamydia screening procedure codes listed (e.g., 86631, 86632, 87491–87494 etc.)

inv-95: Age recommendation — Screen sexually active women <=24 years; women 25+ if at increased risk (USPSTF)

Primary recommendationScreen sexually active women aged ≤24 years; screen women ≥25 years if at increased risk (USPSTF)

ApplicabilityIncludes adolescents and pregnant women per policy notes

Diagnosis requirementClaims must include a pregnancy diagnosis code OR one of the listed screening diagnosis codes

inv-96: Age-based screening guidance — USPSTF: sexually active women ≤24 years; Bright Futures: risk-based screening ages 11–21 years

USPSTF guidanceUSPSTF: screen sexually active women aged ≤24 years; screen women ≥25 years if at increased risk

Bright FuturesBright Futures: risk-based STI screening recommended for adolescents approximately ages 11–21 (if risk assessment positive)

Population noteRecommendation applies to adolescents and adult women, including pregnant women

inv-97: Age guidance — Screening recommended for sexually active women age <=24 and adolescents per Bright Futures (risk-based ages ~11-21)

Age thresholdScreening recommended for sexually active women age ≤24 years

Adolescent guidanceBright Futures: consider STI screening for adolescents aged ~11–21 years when risk assessment is positive

Claim codingScreening claims require pregnancy diagnosis code OR listed screening diagnosis codes to be treated as preventive

inv-98: Age guidance — Screening recommended for sexually active women age <=24 and adolescents per Bright Futures (risk-based ages noted ~11-21)

Recommended ageSexually active women age ≤24 years — routine screening

AdolescentsBright Futures: screen ages ~11–21 when risk assessment positive

Pregnancy inclusionApplies to pregnant persons; pregnancy diagnosis code required on claim when screening pregnant individuals

inv-99: Age threshold for routine screening — Routine screening for sexually active women age 24 years or younger; age 25+ only if increased risk

Routine screening ageAll sexually active women 24 years or younger should be screened routinely

Age 25+ policyWomen 25 years or older should be screened only if at increased risk

Coding requirementChlamydia screening requires an appropriate screening code or pregnancy diagnosis code on the claim

inv-100: Age criteria for routine chlamydia screening — All sexually active women 24 years or younger; women 25 years or older if at increased risk

Primary age criterionAll sexually active women 24 years or younger should receive routine chlamydia screening

Older women guidanceScreen women 25 years or older only if they are at increased risk for infection

Applies to pregnant womenRecommendation explicitly applies to pregnant individuals as part of prenatal care

inv-101: Age-based screening threshold — Screen all sexually active women age 24 years or younger; screen women 25 years or older if at increased risk

Screening thresholdScreen all sexually active women age 24 years or younger

25+ criteriaWomen 25 years or older screened only when at increased risk (specific risk factors referenced to USPSTF but not enumerated in this excerpt)

Supplementary guidanceBright Futures advises STI screening for adolescents ages ~11–21 when risk assessment is positive

inv-102: Adolescent screening window (Bright Futures) — STI screening if risk assessment is positive between ages 11-21 years

Chlamydia screening ageAll sexually active women 24 years or younger should be screened (routine)

Older women guidanceWomen ≥25 years should be screened only if at increased risk (USPSTF-referenced)

Adolescent windowBright Futures: consider STI screening if risk assessment positive between ages 11–21 years

inv-103: Age threshold for chlamydia screening — All sexually active women 24 years or younger; women 25 years or older if at increased risk

Routine age cutoffAll sexually active women 24 years or younger — routine chlamydia screening

25+ screeningWomen 25 years or older are screened only when at increased risk

Claim requirementScreening billed as preventive must include a pregnancy diagnosis code OR one of the listed screening diagnosis codes

Provider Actions & Billing

Note

Code-level certification / payability may apply

Certain procedure codes listed in the preventive services tables may require certification or may not be payable in all circumstances; verify payment eligibility and any certification requirements before billing.

Billing Rule

Verify payability for certain procedure codes

Some procedure codes (for example 81007, 87086, 87088) may not be payable in all cases; providers should verify payment eligibility prior to billing these codes.

Example non-payable/may-not-be-payable codes: 81007, 87086, 87088

Prior Authorization

No prior authorization — billing/diagnosis rules apply

No prior authorization requirements are stated for chlamydia screening in the document; instead, the policy specifies billing and diagnosis requirements that must be met for preventive benefit payment.

Billing Rule

Bill blood draw only with 86631/86632

When applicable, blood draw CPTs must be billed only with the specified lab codes 86631 or 86632; the document requires that blood draw codes accompany those lab codes.

Blood draw codes referenced: 36415, 36416
Must be billed with lab code 86631 or 86632 when applicable

Prior Authorization

No PA — blood draw must be paired with specific lab CPTs and diagnosis

The policy does not require prior authorization; it requires that blood draw codes 36415/36416 be billed with the specific chlamydia lab CPTs (86631/86632) and include appropriate diagnosis coding.

Bill 36415/36416 only with lab codes 86631 or 86632
Include one of the screening diagnosis codes or a pregnancy diagnosis

Prior Authorization

No PA specified for chlamydia screening codes — ensure correct coding

No prior authorization is specified for the listed chlamydia screening procedure codes; however, claims must include the listed procedure/lab code and the required diagnosis coding to qualify as preventive.

Procedure codes include: 86631, 86632, 87110, 87270, 87320, 87490–87494, 87801, 87810
Claims must include a pregnancy diagnosis code OR one of the screening diagnosis codes listed

Prior Authorization

No PA for lab codes 86631/86632 — follow blood draw and diagnosis rules

No prior authorization statements are present for the lab codes 86631/86632; when these lab codes are billed, the policy requires accompanying blood draw and diagnosis coding as specified.

Lab codes: 86631, 86632
Bill with 36415/36416 when a blood draw is performed and include required diagnosis

Prior Authorization

No PA stated for lab screening codes

The document contains no prior authorization language for lab screening codes 86631/86632; billing must follow the stated linkage to blood draw CPTs and diagnosis codes.

Prior Authorization

Screening codes payable when billing rules met (no PA stated)

Listed screening procedure codes are presented as payable when billing and diagnosis requirements are met; no prior authorization requirement is stated for these screening codes.

Billing Rule

Link blood draw CPTs to lab CPTs and diagnosis

Blood draw codes must be billed together with the specified chlamydia lab CPTs (86631/86632) and must include an appropriate screening or pregnancy diagnosis on the claim.

Blood draw CPTs: 36415, 36416
Must be billed with lab code 86631 or 86632 and with a screening diagnosis OR pregnancy diagnosis

Billing Rule

36415/36416 apply only with 86631/86632 and diagnosis

The policy notes that CPTs 36415/36416 are only applicable when billed with lab codes 86631 or 86632 and accompanied by the required screening or pregnancy diagnosis codes.

Do not bill 36415/36416 alone for these preventive screenings
Pair with 86631 or 86632 and include appropriate diagnosis codes

Prior Authorization

No PA — payability depends on correct coding

No explicit prior authorization is required for the preventive STI screening procedure codes in this section; payability depends on correct procedure, lab and diagnosis coding as described.

Prior Authorization

No PA indicated for listed procedure and lab codes

Procedure and lab codes listed for chlamydia and gonorrhea testing (including blood draw codes) do not have an associated prior authorization requirement in the document; follow the billing linkages specified.

Procedure codes listed for chlamydia/gonorrhea
Blood draw codes apply only when billed with 86631 or 86632

Prior Authorization

No PA for screening tests — bill per listed codes

No prior authorization is stated for the listed screening tests; providers should bill using the specified test codes and required diagnosis codes to qualify for preventive payment.

Prior Authorization

No prior authorization statements present

The document set contains no prior authorization statements for the included chunks; providers must follow the billing and diagnosis instructions provided to secure preventive benefit payment.

Denial Risk

General payability caveat — verify before billing

Certain codes may not be payable in all circumstances due to other policies or guidelines; verify code-level payability before submitting claims to avoid denial.

Note

Billing Rule

Observed blood-draw billing linkage

Observed billing guidance in the document emphasizes that blood draw codes (36415/36416) are only payable when billed with lab codes 86631 or 86632 and the claim includes a required screening or pregnancy diagnosis.

Billing Rule

86631/86632 require blood draw + diagnosis

Documented billing notes require that when lab codes 86631/86632 are used, blood draw CPTs be submitted and the claim include one of the screening diagnosis codes or a pregnancy diagnosis to be processed as preventive.

Documentation Required

Claims must include pregnancy OR screening diagnosis

The policy repeatedly states that claims for chlamydia screening require either a pregnancy diagnosis code OR one of the listed screening diagnosis codes; absence of these diagnosis codes risks denial or loss of preventive benefit.

Billing Rule

Blood draw linkage emphasized

Chunk-level billing guidance highlights that blood draw CPTs (36415, 36416) must be billed with the specified lab CPTs and diagnosis codes; failing to do so may result in nonpayment.

Billing Rule

Include 36415/36416 with 86631/86632 and diagnosis

Observed content indicates that when lab codes 86631/86632 are billed, the blood draw codes 36415/36416 and an appropriate screening or pregnancy diagnosis must be included on the claim.

Billing Rule

36415/36416 apply only with 86631/86632 + diagnosis

Chunk-level guidance shows repeated instruction: blood draw codes 36415/36416 apply only with lab codes 86631 or 86632 and require submission of a pregnancy or screening diagnosis code.

Denial Risk

Confirm code payability against other policies

Observed notes caution that certain codes may not be payable in all circumstances; providers should confirm payability relative to other policies before billing.

Denial Risk

Verify applicability of procedure codes

Document excerpts reiterate that some procedure codes may not be payable in all cases; verify eligibility and applicability to the preventive benefit prior to submission.

Billing Rule

Reaffirm blood draw + lab + diagnosis requirement

Billing guidance observed in chunk 180 reiterates that blood draw CPTs must be billed with lab codes 86631/86632 and with a pregnancy or screening diagnosis to qualify for preventive coverage.

Billing Rule

36415/36416 permitted only with 86631/86632 and diagnosis

Chunk 198 confirms that blood draw codes (36415, 36416) only apply with lab codes 86631 or 86632 and must include the required diagnosis codes; no prior authorization is specified.

Denial Risk

Payability depends on correct procedure and diagnosis coding

Chunk 216 reiterates that preventive screening claims require correct test/procedure coding and appropriate diagnosis codes; payability depends on these elements rather than prior authorization.

Billing Rule

Required linkage: blood draw + 86631/86632 + diagnosis

Chunk 234 shows the policy's repeated instruction that blood draw codes apply only with lab codes 86631/86632 and that required diagnosis coding must accompany screening claims for preventive benefit payment.

Documentation Required

Ensure screening/pregnancy diagnosis with blood draw and test codes

Chunk 252 reiterates that blood draw CPTs (36415/36416) and the listed screening procedure codes must be billed with an appropriate screening or pregnancy diagnosis to qualify for preventive coverage.

Documentation Required

Include required diagnosis; note on rating release dates

When billing preventive services, include the appropriate screening or pregnancy diagnosis code as required by the Preventive Benefit Instructions; the document notes that listed dates indicate rating release dates, not benefit effective dates.

Include required diagnosis codes to qualify for preventive benefit
Listed dates are rating release dates (not necessarily benefit effective dates)

Documentation Required

Include lab procedure and pregnancy diagnosis; pair blood draw with lab code

When billing for chlamydia screening, include the applicable lab/procedure code and, when applicable, a pregnancy diagnosis code; bill blood draw CPTs (36415/36416) only when paired with lab codes 86631 or 86632.

Include the specific chlamydia test CPT/HCPCS billed (e.g., 86631/86632, 87491, etc.)
When a blood draw is performed, bill 36415 or 36416 only with 86631/86632

Documentation Required

Require pregnancy OR screening diagnosis; include blood draw when 86631/86632 billed

Claims for chlamydia infection screening must include either a pregnancy diagnosis code or one of the listed screening diagnosis codes; when lab code 86631 or 86632 is billed a blood draw code (36415 or 36416) must also be submitted.

Acceptable screening diagnosis examples: Z00.00, Z00.01, Z00.121, Z00.129, Z11.3, Z11.4, Z11.8, Z11.9, Z20.2, Z20.6, Z29.81, Z72.51–Z72.53
When billing 86631/86632 include 36415 or 36416

Documentation Required

Claim must include pregnancy OR listed screening diagnosis

Submit either a pregnancy diagnosis code OR one of the listed screening diagnosis codes on chlamydia screening claims; absence of these codes will prevent the claim from meeting the preventive benefit instructions.

Billing Rule

36415/36416 — bill only with 86631/86632 and required diagnosis

Blood draw CPTs 36415 and 36416 must be billed only with lab codes 86631 or 86632 and the claim must include either one of the screening diagnosis codes listed or a pregnancy diagnosis code.

36415 / 36416 only allowable with 86631 or 86632
Include screening diagnosis (e.g., Z00.00, Z11.3) or pregnancy diagnosis

Documentation Required

Use pregnancy or appropriate screening diagnosis codes

The policy lists acceptable diagnosis codes for preventive screening claims; use a pregnancy diagnosis when screening pregnant patients or one of the screening/encounter codes (e.g., Z00.00, Z00.01, Z00.121, Z00.129) for preventive visits.

Adult screening: Z00.00, Z00.01
Child screening: Z00.121, Z00.129
Other screening codes: Z11.3, Z11.4, Z11.8, Z11.9, Z20.2, Z20.6

Documentation Required

Use pregnancy DX for pregnant patients or listed screening codes

For screening in pregnancy, include an appropriate pregnancy diagnosis code; for preventive screening visits include one of the screening diagnosis codes listed in the policy (adult or child screening codes as applicable).

Documentation Required

Include pregnancy OR screening diagnosis when billing 36415/36416 with 86631/86632

When billing blood draw CPTs 36415/36416 with lab codes 86631/86632, ensure the claim includes either a pregnancy diagnosis code or one of the listed screening diagnosis codes (examples provided in the policy).

Required diagnoses include pregnancy codes or codes such as Z00.00, Z00.01, Z00.121, Z00.129, Z11.3, Z11.4, Z11.8, Z11.9, Z20.2, Z20.6

Documentation Required

Required screening diagnosis with blood draw + lab codes

Include one of the listed screening diagnosis codes (e.g., Z00.00, Z00.01, Z00.121, Z00.129, Z11.3, etc.) when submitting blood draw codes 36415/36416 with lab codes 86631/86632; failure to include a required diagnosis may result in denial.

Documentation Required

Use appropriate Z00.* or pregnancy diagnosis codes for screening

Claims for preventive screening must include the specified screening or pregnancy diagnosis; use Z00.* codes for routine screening encounters or pregnancy diagnosis codes when screening pregnant patients.

Adult screening: Z00.00 / Z00.01
Child screening: Z00.121 / Z00.129
Other screening codes: Z11.3, Z11.4, Z11.8, Z11.9, Z20.2, Z20.6

Documentation Required

Use pregnancy DX for pregnant specimens; Z00.* for preventive visits

Use a pregnancy diagnosis code when the specimen is from a pregnant member; for preventive screening visits use adult (Z00.00/Z00.01) or child (Z00.121/Z00.129) screening encounter codes as applicable.

Denial Risk

Missing required diagnosis may cause non-payability

When billing preventive chlamydia screening, include either a pregnancy diagnosis code or one of the listed screening diagnosis codes (examples provided) to meet the preventive benefit instructions; missing the required diagnosis may render the claim non-payable.

Documentation Required

Required diagnosis determines preventive benefit eligibility

Use the pregnancy diagnosis code for pregnant patients or one of the listed screening diagnosis codes for preventive visits; failure to submit the required diagnosis will prevent the service from qualifying as preventive under the policy.

Denial Risk

Non-payable code caution — verify before submission

The policy repeatedly cautions that certain procedure codes may not be payable in all contexts; verify code payability and any applicable exclusions prior to billing to avoid claim denial.

Note

Background

Background: Preventive services include routine health/wellness exams, vaccinations, and well‑child care intended for persons without symptoms or prior abnormal findings. When a service is performed and appropriately reported as preventive, it is considered under the HealthChoice preventive care benefit; diagnostic services (for abnormal findings or symptoms) are covered under standard plan benefits. The policy references guideline sources including the USPSTF, ACIP, HRSA and Bright Futures to define covered preventive services.

Definitions

Policy Summary

PayerHealthChoice of Oklahoma

PolicyPreventive Services

Policy CodePolicy N/A

Change TypeNo material change

Effective DateJul 1, 2026

Last ReviewNov 20, 2025

Next Review DateN/A

SourceLink

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Preventive Services

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Coverage Criteria

General preventive coverage criteria

Covered when ALL of the following are met

Preventive visit coverage: Service is preventive (no prior abnormality or symptoms, or prior screening was normal and follow-up is per recommended intervals)

As defined in policy text

Provider: Rendered by a participating network provider

Preventive care covered at 100% of allowable amounts when rendered by participating providers

Guideline alignment: Service aligns with USPSTF A/B, ACIP, HRSA or Bright Futures recommendations as applicable

Document references these guideline sources as defining preventive services

AAA screening

Covered when ALL of the following are met

Population: Male aged 65 through 75 years (ends on 76th birthday)age 65-75

Per USPSTF recommendation cited in row

Smoking history: Has ever smokedhistory of smoking required

Policy row references diagnosis codes indicating tobacco use/history

Procedure code: Ultrasound CPT 76706 documentedCPT 76706

Table lists 76706 for AAA screening

Bacteriuria screening in pregnancy

Covered when ALL of the following are met

Population: Pregnant personpregnancy diagnosis code present

Table rows require a pregnancy diagnosis code for coverage

Procedure codes: Urine culture/testing CPT codes (81007, 87086, 87088) as listedCPT 81007/87086/87088

Policy lists these procedure codes for bacteriuria screening

Chlamydia screening

Covered when ANY of the following population criteria are met (AND test coded as listed)

Population: Sexually active women age <=24 OR other sexually active women at increased riskage <=24 or other risk

Reflects USPSTF recommendation cited in table

Test codes: One of the listed chlamydia procedure codes billed (e.g., 86631, 86632, 87110, 87270, 87320, 87490-87494, 87801, 87810)listed CPT/HCPCS/lab codes

Rows require these procedure codes

Pregnancy option: Alternatively requires a pregnancy diagnosis code for pregnancy-specific screeningpregnancy diagnosis present

Table indicates pregnancy diagnosis allows coverage

Chlamydia screening (preventive)

Covered preventive screenings when applicable USPSTF recommendations and diagnosis codes are present

Requires appropriate screening or pregnancy diagnosis code on claim

Asymptomatic bacteriuria screening (pregnancy)

Covered preventive screenings when USPSTF A recommendation applies

Asymptomatic bacteriuria screening in pregnancy: Screening for asymptomatic bacteriuria using urine culture in pregnant persons per USPSTF A recommendationpregnancy diagnosis code present

Urine culture codes listed; some procedure codes may not be payable in all cases

Preventive coverage conditions

Covered when the following billing/diagnosis conditions are met:

Blood draw codes only apply to lab codes 86631 or 86632; claims lacking required diagnosis or blood draw coding may not qualify for the preventive benefit.

Preventive screening coverage criteria

Covered when ALL of the following are met:

Billing linkage: The blood draw code (36415 or 36416) must be billed with lab code 86631 or 86632 when applicable.

Blood draw codes only apply to lab codes 86631 or 86632.

Diagnosis requirement: A Pregnancy diagnosis code OR one of the screening diagnosis codes listed in the policy row must be submitted with the chlamydia screening claim.

Applies specifically for pregnant persons and related rows in the document.

USPSTF Rating B cited (Sept 2021).

Covered with billing/diagnosis criteria

Covered when ALL of the following billing conditions are met:

Codes listed across chunks 72-76

Document repeatedly states this requirement (chunks 72-76)

Chunks 86-91

Preventive chlamydia screening coverage

Covered when screening aligns with USPSTF/Bright Futures recommendations and appropriate coding/billing is used

Follows USPSTF (Sept 2021) and Bright Futures guidance as cited.

Preventive coverage criteria

Covered when ALL of the following are met

Blood draw codes (36415, 36416) are allowed only when billed with lab codes 86631 or 86632 and accompanied by the required diagnosis code(s).

Preventive Screening Coverage Conditions

Covered when billing meets diagnostic and coding requirements:

Billing requirements: Claim includes one of the listed screening procedure codes (86631, 86632, 87110, 87270, 87320, 87490, 87491, 87492, 87494, 87801, 87810).

Procedure codes listed across multiple chunks.

Explicit requirement repeated in multiple chunks.

Preventive Screening — Coverage Criteria

Covered when documentation supports screening per USPSTF/Bright Futures guidance and billing rules are followed

This chunk-level criteria reflects instructions present in the file; the document indicates some codes 'may not be payable in all' circumstances.

Preventive Screening Coverage Criteria

Covered when ALL of the following are met

Support: chunks 162,166

Support: chunks 162,163,167

Chlamydia screening — Covered criteria

Covered when ALL of the following apply

Applies to chlamydia; gonorrhea screening procedure codes are listed alongside chlamydia codes; blood draw codes apply when used with specified lab codes.

Chlamydia screening — USPSTF recommendation

Covered when USPSTF recommends screening for the population below:

Population who should be screened: Sexually active women 24 years or youngerage <= 24

Includes adolescents and pregnant women as stated

Older women screening indication: Women 25 years or older who are at increased risk for infectionage >= 25 AND risk factors present

Risk assessment per Bright Futures recommended between ages 11-21 for adolescents; specific risk factors not listed in this excerpt

Preventive screening criteria

Covered when any of the following apply

All sexually active women <=24: Screening is recommended for all sexually active women 24 years or younger.age <= 24 years

Applies to adolescents, adults, and pregnant women

Women 25+ at increased risk: Screening is recommended for women 25 years or older who are at increased risk for chlamydia infection.age >= 25 with increased risk

'Increased risk' not defined in this excerpt

Bright Futures recommendation: Bright Futures recommends STI screening if risk assessment is positive between ages 11-21.age 11-21 with positive risk assessment

Supplementary guidance for adolescents

Chlamydia screening (USPSTF)

Covered when the USPSTF recommendations are met:

Bright Futures also recommends screening for adolescents 11-21 years if risk assessment is positive.

Gonorrhea screening (USPSTF)

Covered when the USPSTF recommendation for gonorrhea screening is met:

Document references USPSTF rating B (Sept 2021).

Preventive screening recommendations (USPSTF)

Covered when the following USPSTF and Bright Futures recommendations apply:

Bright Futures recommends STI screening if risk assessment is positive between ages 11-21.

Recommendation applies to pregnant women as well.

Coding

Abdominal Aortic Aneurysm screening CPTCPTCovered

76706

Ultrasound Screening Study for Abdominal Aortic Aneurysm

Bacteriuria and pregnancy-related urine testingCPTCovered

81007	Urinalysis, non-automated
87086	Urine culture
87088	Urine culture with organism identification

Chlamydia infection screening CPT/assay codesCPTCovered

86631	Chlamydia antigens
86632	Chlamydia antigens (alternate)
87110	Culture for chlamydia
87270	Chlamydia culture (cell culture)
87320	Chlamydia NAAT or antigen
87490	Chlamydia NAAT - unlisted
87491	Chlamydia NAAT - single target
87492	Chlamydia NAAT - multiple targets
87494	Chlamydia/GC multiplex NAAT
87801	Chlamydia direct probe

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Diagnosis codes referenced in table rowsICD-10

F17.210	Nicotine dependence, cigarettes, uncomplicated
F17.211	Nicotine dependence, cigarettes, in remission
F17.213	Nicotine dependence, cigarettes with withdrawal
F17.218	Other nicotine dependence
F17.219	Nicotine dependence, unspecified
Z87.891	Personal history of nicotine dependence

Pregnancy-related diagnosis requirementICD-10

Pregnancy Diagnosis Codes

Various ICD-10 pregnancy diagnosis codes referenced for pregnancy-specific screenings

Chlamydia Infection Screening CPT/HCPCS/Lab CodesmixedCovered

86631	Chlamydia infection screening (lab code) (as listed)
86632	Chlamydia infection screening (lab code) (as listed)
87110	Culture, chlamydia (as listed)
87270	Chlamydia test (as listed)
87320	Chlamydia test (as listed)
87490	Chlamydia test (as listed)
87491	Chlamydia NAAT (as listed)
87492	Chlamydia NAAT (as listed)
87494	Chlamydia test (as listed)
87801	Chlamydia antigen test (as listed)

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Blood draw codesCPT

36415	Collection of venous blood by venipuncture (blood draw)
36416	Collection of capillary blood specimen (blood draw)

Urine culture / related procedure codes (payment may vary)CPT

81007	Urinalysis (may not be payable in all cases)
87086	Culture, bacterial; quantitative colony count (as listed)
87088	Urine culture, colony count (as listed)

Covered lab/procedure codes for chlamydia screeningCPT|HCPCSCovered

86631	Chlamydia infection screening (laboratory)
86632	Chlamydia infection screening (laboratory)
87110	Culture, chlamydia
87270	Chlamydia NAAT/other
87320	Trichomonas/other protozoa testing (listed here)
87490	Chlamydia NAAT, unspecified specimen
87491	Chlamydia NAAT, pelvic swab
87492	Chlamydia NAAT, urethral swab
87494	Chlamydia NAAT, other
87801	Chlamydia diagnostic test

1–10 of 11

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Blood draw codes (required with certain lab codes)CPTCovered

36415	Collection of venous blood by venipuncture
36416	Collection of capillary blood sample

Urine culture/related procedure codes referencedCPTCovered

81007	Urinalysis, by dipstick
87086	Urine culture with isolation
87088	Urine culture with colony count

Chlamydia Infection Screening CPT/CLIA CodesCPTCovered

86631	Chlamydia infection screening (lab code) from document
86632	Chlamydia infection screening (lab code) from document
87110	Chlamydia Infection Screening (procedure code) from document
87270	Chlamydia Infection Screening (procedure code) from document
87320	Chlamydia Infection Screening (procedure code) from document
87490	Chlamydia Infection Screening (procedure code) from document
87491	Chlamydia Infection Screening (procedure code) from document
87492	Chlamydia Infection Screening (procedure code) from document
87494	Chlamydia Infection Screening (procedure code) from document
87801	Chlamydia Infection Screening (procedure code) from document

1–10 of 11

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Blood draw codes (only apply with specific lab codes)CPT

36415	Collection of venous blood by venipuncture (blood draw) — applicable when billed with 86631 or 86632
36416	Collection of capillary blood — applicable when billed with 86631 or 86632

Chlamydia Infection Screening CPT/LOINC/etcmixedCovered

86631	Chlamydia Infection Screening (lab code) listed
86632	Chlamydia Infection Screening (lab code) listed
87110	Chlamydia Infection Screening (procedure code)
87270	Chlamydia Infection Screening (procedure code)
87320	Chlamydia Infection Screening (procedure code)
87490	Chlamydia Infection Screening (procedure code)
87491	Chlamydia Infection Screening (procedure code)
87492	Chlamydia Infection Screening (procedure code)
87494	Chlamydia Infection Screening (procedure code)
87801	Chlamydia Infection Screening (procedure code)

1–10 of 11

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Blood draw codes (only applicable with lab codes 86631/86632)CPTCovered

36415	Blood draw
36416	Blood draw

Diagnosis codes (preventive visit / screening / pregnancy)ICD-10

Z00.00	Adult preventive encounter
Z00.01	Adult preventive encounter with findings
Z00.121	Child preventive visit (with or without newborn)
Z00.129	Child preventive visit (unspecified)

Pregnancy diagnosis codesICD-10

Pregnancy Diagnosis Code

Generic reference to pregnancy diagnosis codes required when applicable

Chlamydia Infection Screening (procedure CPT/HCPCS)CPTCovered

86631	Chlamydia infection screening (laboratory) - listed
86632	Chlamydia infection screening (laboratory) - listed
87110	Culture identification, chlamydia - listed
87270	Direct fluorescent antibody - listed
87320	Chlamydia trachomatis detection - listed
87490	Infectious agent detection by nucleic acid (chlamydia) - listed
87491	Chlamydia NAT, amplified probe - listed
87492	Chlamydia NAT, direct probe - listed
87494	Chlamydia detection by probe technique - listed
87801	Antigen detection (chlamydia) - listed

1–10 of 11

1/2

Blood draw CPTs (apply when billing 86631 or 86632)CPTCovered

36415	Collection of venous blood by venipuncture
36416	Collection of capillary blood specimen (e.g., finger, heel)

Diagnosis / Screening encounter codesICD-10

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
Z11.4	Encounter for screening for other infectious and parasitic diseases
Z11.8	Encounter for screening for other infectious and parasitic diseases (other)
Z11.9	Encounter for screening, unspecified
Z20.2	Contact with and (suspected) exposure to infections with a predominantly sexual mode of transmission
Z20.6	Contact with and (suspected) exposure to other communicable diseases

Pregnancy diagnosis (generic)ICD-10

Pregnancy Diagnosis Code

Documented pregnancy diagnosis code required when screening pregnant persons (exact pregnancy codes referenced generically in document)

Covered laboratory / screening CPT/HCPCS codesmixedCovered

86631	Chlamydia Infection Screening
86632	Chlamydia Infection Screening
87110	Chlamydia Infection Screening
87270	Chlamydia Infection Screening
87320	Chlamydia Infection Screening
87490	Chlamydia Infection Screening
87491	Chlamydia Infection Screening
87492	Chlamydia Infection Screening
87494	Chlamydia Infection Screening
87801	Chlamydia Infection Screening

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Blood draw CPT codes (allowed only with specific lab codes)CPTCovered

36415	Venipuncture (blood draw)
36416	Collection of capillary blood specimen (blood draw)

Allowed screening and related diagnosis codesICD-10

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
Z11.4	Encounter for screening for other infectious and parasitic diseases
Z11.8	Encounter for screening for other infectious and parasitic diseases
Z11.9	Encounter for screening, unspecified
Z20.2	Contact with and (suspected) exposure to infections with a predominantly sexual mode of transmission
Z20.6	Contact with and (suspected) exposure to viral hepatitis

1–10 of 14

1/2

Chlamydia Infection Screening Procedure CodesCPTCovered

86631	Chlamydia infection screening (serology) - listed
86632	Chlamydia infection screening (serology) - listed
87110	Culture
87270	Wet mount/other microscopy
87320	Chlamydia antigen detection
87490	Chlamydia NAAT
87491	Chlamydia NAAT
87492	Chlamydia NAAT
87494	Chlamydia/gonorrhea combo NAAT
87801	Infectious agent detection

1–10 of 11

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Blood Draw Codes (must accompany specific lab codes)CPTCovered

36415	Collection of venous blood by venipuncture
36416	Collection of capillary blood

Applicable Screening & Pregnancy Diagnosis CodesICD-10

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
Z11.4	Encounter for screening for viral diseases
Z11.8	Encounter for screening for other infectious and parasitic diseases
Z11.9	Encounter for screening, unspecified
Z20.2	Contact with and (suspected) exposure to infections with a predominantly sexual mode of transmission
Z20.6	Contact with and (suspected) exposure to HIV

1–10 of 14

1/2

Chlamydia and Gonorrhea Screening / Blood drawCPTCovered

86631	Chlamydia/C. trachomatis test (document lists as chlamydia infection screening)
86632	Companion chlamydia test code (document lists as chlamydia infection screening)
87110	Microbial culture (code listed in screening set)
87270	Aerobic bacterial smear/culture code (listed)
87320	Chlamydia trachomatis antigen detection (listed)
87490	Chlamydia NAAT (listed)
87491	Chlamydia NAAT genital (listed)
87492	Chlamydia NAAT non-genital (listed)
87494	Chlamydia test code (listed)
87801	Gonorrhea/chlamydia test (listed)

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Screening/diagnosis codesICD-10

Z00.00	Screening – general adult (listed as screening diagnosis)
Z00.01	Screening – general adult with abnormal findings (listed)
Z00.121	Child health exam without abnormal findings (listed)
Z00.129	Child health exam unspecified (listed)
Z11.3	Encounter for screening for hepatitis (listed among screening codes)
Z11.4	Encounter for screening for infections with a predominantly sexual mode of transmission (listed)
Z11.8	Encounter for other infectious and parasitic disease screening (listed)
Z11.9	Encounter for screening, unspecified (listed)
Z20.2	Contact with and (suspected) exposure to infections with predominantly sexual transmission (listed)
Z20.6	Contact with and (suspected) exposure to HIV (listed)

1–10 of 14

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Covered CPT/HCPCS codes for chlamydia/gonorrhea screening and blood drawmixedCovered

86631	Chlamydia trachomatis antigen detection (lab code listed)
86632	Chlamydia trachomatis antigen detection (lab code listed)
87110	Culture, chlamydia/gonorrhea (procedure code listed)
87270	Cell culture identification (procedure code listed)
87320	Chlamydia assay (procedure code listed)
87490	Infectious agent detection by nucleic acid (listed)
87491	Infectious agent detection by nucleic acid (listed)
87492	Infectious agent detection by nucleic acid (listed)
87494	Infectious agent detection by nucleic acid (listed)
87801	Antigen detection test (listed)

1–10 of 17

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Permissible screening/diagnosis ICD-10 codes for preventive screeningmixed

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
Z11.4	Encounter for screening for viral diseases
Z11.8	Encounter for other infectious and parasitic diseases
Z11.9	Encounter for screening, unspecified
Z20.2	Contact with and (suspected) exposure to infections with predominantly sexual transmission
Z20.6	Contact with and (suspected) exposure to HIV

1–10 of 14

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Chlamydia-related lab/test codesmixedCovered

87491	87491 (screening test code cited)
87492	87492 (screening test code cited)
87494	87494 (screening test code cited)
87801	87801 (screening test code cited)
87810	87810 (screening test code cited)
86631	Chlamydia antigen/antibody lab code
86632	Chlamydia antigen/antibody lab code
87110	Culture/microbiology code cited
87270	Microbiology culture/stain code cited
87320	Test code cited

1–10 of 11

1/2

Gonorrhea Screening Procedure CodesCPTCovered

87590	Gonorrhea screening procedure code
87591	Gonorrhea screening procedure code
87592	Gonorrhea screening procedure code
87850	Gonorrhea screening procedure code

Blood draw codesCPT

36415	Collection of venous blood by venipuncture (blood draw)
36416	Collection of capillary blood (blood draw)

Diagnosis / encounter codesICD-10

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
Z11.4	Encounter for screening for viral diseases
Z11.8	Encounter for screening for other specified infectious and parasitic diseases
Z11.9	Encounter for screening, unspecified
Z20.2	Contact with and (suspected) exposure to infections with a predominantly sexual mode of transmission
Z20.6	Contact with and (suspected) exposure to viral hepatitis

1–10 of 14

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Gonorrhea / NAAT procedure codes repeatedCPTCovered

87590	Gonorrhea Screening Procedure Code (document lists)
87591	Gonorrhea Screening Procedure Code (document lists)
87592	Gonorrhea Screening Procedure Code (document lists)
87801	Gonorrhea Screening Procedure Code (document lists)
87850	Gonorrhea Screening Procedure Code (document lists)

Additional chlamydia/gonorrhea procedure codesCPTCovered

87491	Chlamydia/Gonorrhea amplification test (document lists)
87492	Chlamydia/Gonorrhea amplification test (document lists)
87494	Chlamydia/Gonorrhea related procedure code (document lists)
87810	Additional STI test procedure code referenced

Blood draw codesCPT

36415	Blood draw (venipuncture)
36416	Blood draw (capillary or other) — listed as blood draw codes

Lab (serology) codesCPT

86631	Serologic test lab code referenced (blood draw codes only apply to lab codes 86631 or 86632)
86632	Serologic test lab code referenced (blood draw codes only apply to lab codes 86631 or 86632)

Diagnosis / screening encounter codesICD-10

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
Z11.4	Encounter for screening for other infectious and parasitic diseases
Z11.8	Encounter for screening for other specified infectious and parasitic diseases
Z11.9	Encounter for screening, unspecified
Z20.2	Contact with and (suspected) exposure to infections with a predominantly sexual mode of transmission
Z20.6	Contact with and (suspected) exposure to viral hepatitis

1–10 of 14

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Chlamydia testing CPT/HCPCS codesmixedCovered

87491	Chlamydia NAAT (document lists 87491 as a testing code)
87492	Chlamydia NAAT (document lists 87492 as a testing code)
87494	Chlamydia/GC test (listed among testing codes)

Gonorrhea testing CPT/HCPCS codesmixedCovered

87590	Gonorrhea test (document lists 87590)
87591	Gonorrhea test (document lists 87591)
87592	Gonorrhea test (document lists 87592)
87801	Gonorrhea/chlamydia test (listed)
87810	Listed in places among procedure codes (appears related to GC testing)
87850	Gonorrhea testing code (listed)

Blood draw codesCPT

36415	Collection of blood by venipuncture (blood draw)
36416	Collection of blood venous (second code listed)

Lab (microscopy/serology) codes referenced for blood drawCPT

86631	Chlamydia serology/lab code (blood draw codes only apply to lab codes 86631 or 86632)
86632	Chlamydia serology/lab code (paired with blood draw codes)

Diagnosis and screening encounter codesICD-10

Z00.00	General adult health examination without abnormal findings
Z00.01	General adult health 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
Z11.4	Encounter for screening for bacterial diseases
Z11.8	Encounter for screening for other infectious and parasitic diseases
Z11.9	Encounter for screening, unspecified
Z20.2	Contact with and (suspected) exposure to infections with a predominantly sexual mode of transmission
Z20.6	Contact with and (suspected) exposure to viral hepatitis

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Procedure Codes (screening tests)CPTCovered

87590	Chlamydia/Gonorrhea testing (document lists as Procedure Code)
87591	Chlamydia/Gonorrhea testing (document lists as Procedure Code)
87592	Chlamydia/Gonorrhea testing (document lists as Procedure Code)
87801	Chlamydia/Gonorrhea testing (document lists as Procedure Code)
87850	Chlamydia/Gonorrhea testing (document lists as Procedure Code)

Additional laboratory procedure codes referencedCPTCovered

87491	Test code listed in document (context: STI screening)
87492	Test code listed in document (context: STI screening)
87494	Test code listed in document (context: STI screening)

Blood draw CPT codesCPT

36415	Collection of venous blood by venipuncture
36416	Collection of capillary blood specimen (e.g., finger, heel)

Laboratory (test) codes referenced for blood draw applicabilityCPT

86631	Serology/lab code referenced as applicable with blood draw
86632	Serology/lab code referenced as applicable with blood draw

Diagnosis Codes (screening / pregnancy / exposure / risk behavior)ICD-10

Z00.00	General adult health examination without abnormal findings (screening) - listed
Z00.01	General adult health exam with abnormal findings - listed as screening example
Z00.121	Encounter for routine child health exam with abnormal findings (listed)
Z00.129	Encounter for routine child health examination without abnormal findings (listed)
Z11.3	Encounter for screening for infections with a predominantly sexual mode of transmission
Z11.4	Encounter for screening for other infectious and parasitic diseases
Z11.8	Encounter for screening for other specified infectious and parasitic diseases
Z11.9	Encounter for screening, unspecified
Z20.2	Contact with and (suspected) exposure to chlamydia
Z20.6	Contact with and (suspected) exposure to viral hepatitis

1–10 of 14

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Gonorrhea screening procedure codesCPTCovered

87590	Infectious agent detection by nucleic acid (document lists as gonorrhea screening procedure code)
87591	Infectious agent detection by nucleic acid
87592	Infectious agent detection by nucleic acid
87801	Infectious agent antigen detection; gonorrhea (document lists as screening code)
87850	Infectious agent antigen detection; gonorrhea (alternate listed code)

Chlamydia screening procedure codes (additional listed)CPTCovered

87491	Infectious agent detection by nucleic acid; chlamydia (listed)
87492	Infectious agent detection by nucleic acid; chlamydia
87494	Infectious agent detection; chlamydia (listed)

Blood draw codesCPT

36415	Collection of venous blood by venipuncture
36416	Collection of capillary blood (blood draw codes referenced for lab collection)

Screening diagnosis codesICD-10

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
Z11.4	Encounter for screening for HIV
Z11.8	Encounter for screening for other infectious and parasitic diseases
Z11.9	Encounter for screening, unspecified
Z20.2	Contact with and (suspected) exposure to infections with predominantly sexual transmission
Z20.6	Contact with and (suspected) exposure to HIV