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Elizabeth M. Whitehorn, Director

Provider Notice issued 05/09/11

 

To: Participating Advanced Practice Nurses, Federally Qualified Health Centers (FQHC), Encounter Rate Clinics (ERC), Rural Health Clinics (RHC), Local Health Departments, Hospitals, and Physicians

Date: May 9, 2011

Re: Billing for Preventive Services

 

The purpose of this notice is to remind providers of the department's coverage policy for preventive services. To receive reimbursement for these services, providers must provide services in accordance with the guidelines set forth by the American Medical Association (AMA) for the preventive evaluation and management CPT codes.

 

Preventive Services for Children age 0 to 20

HFS recommends that health screenings be provided to children, on a periodicity schedule based on acceptable medical practice standards, such as the schedule recommended by the American Academy of Pediatrics (AAP) or the American Academy of Family Physicians (AAFP), or the well child visit and periodicity schedule located in the Handbook for Providers of Healthy Kids Services, Topic HK-203.1.1. Payment will be limited to visits in accordance with the appropriate periodicity schedule for the child's age.

 

Preventive Services for Adults age 21 and older

 

To receive reimbursement for these services, providers must bill the age-appropriate preventive evaluation and management CPT codes. Payment will be limited to one preventive office visit per patient, per provider, per year.

 

Questions regarding this notice may be directed to the Bureau of Comprehensive Health Services at 1-877-782-5565.

 

Theresa A. Eagleson, Administrator

Division of Medical Programs