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Preventive service codes

These codes correlate to our Preventive Health Care Guidelines. Use this chart for reference only; refer to the current CPT manual for a complete description of each code and the most updated code lists.

Changes in women's preventive health care

As a part of the Affordable Care Act (health care reform), women's preventive health care changes rolled out for new business and as current groups renew on or after Aug. 1, 2012. They are included in the charts below.

Exceptions:

  • Benefits will not change for "grandfathered" plans. 
  • Certain religious employers can claim exemption from the contraceptive methods, counseling and  sterilizations for women.
  • Certain religious organizations can claim a safe harbor exemption from covering contraceptive methods and counseling. 

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See also in this manual:

CPT code Description Comments
COLORECTAL CANCER SCREENINGS
45330-45339, G0104, G0106 Sigmoidoscopy, flexible; diagnostic ...
  • If the purpose of the test was preventive, the procedure is considered preventive even when polyps are removed.
  • The claim system cannot tell if the purpose of the test was preventive or diagnostic. If the deductible is applied, send in the medical record indicating the purpose of the test and the claim will be reviewed and adjusted if appropriate.
  • G codes are for Medicare members only.
45378, 45380, 45382-45385, G0105, G0120, G0121 Colonoscopy, flexible, proximal to splenic flexure; diagnostic ...
  • If the purpose of the test was preventive, the procedure is considered preventive even when polyps are removed.
  • The claim system cannot tell if the purpose of the test was preventive or diagnostic. If the deductible is applied, send in the medical record indicating the purpose of the test and the claim will be reviewed and adjusted if appropriate.
  • G codes are for Medicare members only.
74263 Computed tomographic (CT) colonography, screening, including image postprocessing Subject AIM authorization requirements.
74270, 74280, G0106, G0120, G0122 Barium enema
74270: Radiologic examination, colon; barium enema, with or without KUB
74280: Air contrast with specific high-density barium, with or without glucagon
99144 Moderate sedation services by same physician w/observer, age 5 years or older, first 30 min. Clinical edit: This line will deny as a subset due to clinical edit when billed with colonoscopy.
99145 Moderate sedation services by same physician w/observer, age 5 years or older, each additional 15 min. Clinical edit: This line will deny as a subset due to clinical edit when billed with colonoscopy.
00810 Anethesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum
RADIOLOGY
G0202 Screening mammography, producing direct digital image, bilateral, all views
G0204 Diagnostic mammography, producing direct digital image, bilateral, all views
G0206 Diagnostic mammography, producing direct digital image, unilateral, all views
77051 Computer-aided detection, w/ or w/o digitization of radiographic images; screening mammogram (add-on code)
77052 Computer-aided detection with further physician review for interpretation, with or without digitization of film radiographic images;screening mammography (add-on code)
77055 Mammography; unilateral
77056 Mammography; bilateral
77057 Screening mammography, bilateral (two-view film study of each breast)
75625, 93544 Aortography, abdominal, by serialography, radiological supervision and interpretation
Injection procedure during cardiac catheterization; for aortography
Clinical test for men 65+ per Preventive Health Care Guidelines
LABS
36415 Collection of venous blood by venipuncture
80061 Lipid panel
82465 Cholesterol, serum or whole blood total
82270, 82274 Blood, occult
G0328 Colorectal cancer screening; fecal occult blood test Medicare only
82947 Glucose quantitative, blood (except reagent strip)
82948 Glucose quantitative, blood
82950 Post glucose dose
83655 Lead screening
83718 Lipoprotein, direct measurement; high density cholesterol (HDL cholesterol)
83721 Direct measurement LDL cholesterol
84478 Triglycerides 
85014 Hematocrit
85018 Hemoglobin
85025, 85027 Complete CBC
86580 Tuberculin skin test
86592 Syphilis test, non-treponemal antibody; qualitative (e.g., VDRL, RPR, ART)
86701-86073 HIV
86762 Rubella antibody (titer)
87110, 87270, 87320, 87490-87492 Chlamydia
87590-87592, 87802, 87810, 87850 Neisseria gonorrhoeae
87620-87622 HPV Preventive for female only. Update for women's preventive health care guidelines as a part of the Affordable Care Act (Health Care Reform).
G0432 Infectious agent antibody detection by enzyme immunoassay (EIA) technique, HIV-1 and/or HIV-2, screening Preventive for female only. Update for women's preventive health care guidelines as a part of the Affordable Care Act (Health Care Reform).
G0433 Infectious agent antibody detection by enzyme-linked immunosorbent assay (ELISA) technique, HIV-1 and/or HIV-2, screening Preventive for female only. Update for women's preventive health care guidelines as a part of the Affordable Care Act (Health Care Reform).
G0435 Infectious agent antigen detection by rapid antibody test of oral mucosa transudate, HIV-1 or HIV-2, screening Preventive for female only. Update for women's preventive health care guidelines as a part of the Affordable Care Act (Health Care Reform).
88141-88143, 88147-88155, 88164-88167, 88174-88175 Cytopathology ... cervical or vaginal
VACCINES
90460-90461, 90471-90474 Immunization administration Use the corresponding diagnosis and CPT codes appropriate for members age.
Also see notes on Medicaid & Medicare patients under Vaccines.
90644 Meningococcal confugate vaccine *Will verify FDA Approval prior to addition to preventive list. If no approval, will not add to list.
90645-90648 Hebophilus influenza b vaccine Use the corresponding diagnosis and CPT codes.
771 Vaccine administration For claims submitted on a UB92: This REV code must be billed with the correct procedure code.  For Medicare patients: Follow the Medicare guidelines for immunizations
G0008 Administration of influenza virus vaccine Medicare only: Must be billed with REV code 771
G0009 Administration of pneumococcal vaccine Medicare only: Must be billed with REV code 771
90632-90636 Hepatitis A Use the corresponding diagnosis and CPT codes.
90649-90650 HPV CPT 90650 for females only. Use the corresponding diagnosis and CPT codes.
90655-90660
Q2035-Q2039
Influenza… Use the corresponding diagnosis and CPT codes.
Medicare patients: Utilize appropriate Q code effective 1/1/2011 in place of CPT 90658.
Also see Billing for flu shots in this manual.
90669 Pneumococcal conjugate vaccine, polyvalent… Use the corresponding diagnosis and CPT codes.
90672 Influenza virus vaccine, quadrivalent, live, for internasal use Use the corresponding diagnosis and CPT codes.
90680-90681 Rotavirus Use the corresponding diagnosis and CPT codes.
90696 Diphtheria, tetanus toxoids, acellular pertussis, vaccine and poliovirus vaccine, inactivated (DTaP-IPV... Use the corresponding diagnosis and CPT codes.
90698-90702 DTap,-Hib-IPV, STaP, DTP, DT Use the corresponding diagnosis and CPT codes.
90703 Tetanus... Use the corresponding diagnosis and CPT codes.
90704-90710 Mumps, measles, rubella Use the corresponding diagnosis and CPT codes.
90712-90713 Poliovirus vaccine Use the corresponding diagnosis and CPT codes.
90714-90715 Td, Tdap Use the corresponding diagnosis and CPT codes.
90716 Varicella vaccine Use the corresponding diagnosis and CPT codes.
90718-90723 Tetanus and diphtheria toxoids Use the corresponding diagnosis and CPT codes.
90732 Pneumoccoal polysaccharide vaccine… Use the corresponding diagnosis and CPT codes.
90733-90734 Meningococcal polysaccharide vaccine Use the corresponding diagnosis and CPT codes.
90736 Zoster (shingles) vaccine, live for subcutaneous injection Specific coverage as preventive for 60+ age group
90740-90748 Hepatitis B vaccine… Use the corresponding diagnosis and CPT codes.
636 Drugs requiring detailed coding For claims submitted on a UB92: This code must be billed with the corresponding CPT code.
PREVENTIVE MEDICINE
99381-99387 New patient preventive visit ...
99391-99397 Established patient preventive visit ...
99460 Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant
99461 Initial care, per day, for evaluation and management of normal newborn infant seen in other than hospital or birthing center
99462 Subsequent hospital care, per day, for evaluation and management of normal newborn
99463 Initial hospital or birthing center care, per day, for evaluation and management of normal newborn infant admitted and discharged on the same date
92551 Screening test, pure tone, air only
96110 Developmental screening, with interpretation and report, per standardized instrument form
99173 Screening test of visual acuity, quantitative, bilateral
G0101 Cervical or vaginal cancer screening; pelvic and clinical breast examination Medicare members only. Do not report in conjunction with 99381-99397.
Refer to guidelines on preventive services.
G1002 Prostate cancer screening; digital rectal examination Medicare members only. Do not report in conjunction with 99381-99397.
Refer to guidelines on preventive services.
G0438 Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit Medicare members only. Do not report in conjunction with 99381-99397.
Refer to guidelines on preventive services.
G0439 Annual wellness visit; includes a personalized prevention plan of service (pps), subsequent visit Medicare members only. Do not report in conjunction with 99381-99397.
Refer to guidelines on preventive services.
Q0091 Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory Medicare members only. Do not report in conjunction with 99381-99397.
Refer to guidelines on preventive services.
PREVENTIVE COUNSELING
96040 Medical genetics and genetic counseling services, each 30 minutes face-to-face with patient/family
97802 Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes
97803 Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes
97804 Medical nutrition therapy; group (2 or more individuals), each 30 minutes
99401-99404 Preventive medicine counseling
99420 Administration and interpretation ...
99406 Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes
99407 Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes
G0436 Smoking and tobacco cessation counseling visit for the asymptomatic patient; intermediate, greater than 3 minutes, up to 10 minutes
G0437 Smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes
G0442 Annual alcohol misuse screening, 15 mins Medicare members only.
G0443 Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes Medicare members only.
G0445 Semiannual high intensity behavioral counseling to prevent STIs, individual, face-to-face, includes education skills training & guidance on how to change sexual behavior Preventive for female only. Update for women's preventive health care guidelines as a part of the Affordable Care Act (Health Care Reform).
G0447 Face-to-face behavioral counseling for obesity, 15 minutes Medicare members only.
G0449 Annual face-to-face obesity screening, 15 minutes Medicare members only.
99408 Alcohol and/or substance (other than tobacco) structured screening (e.g., AUDIT, DAST) and brief intervention (SBI) services; 15 to 30 minutes
99409 Alcohol and/or substance (other than tobacco) structured screening (e.g., AUDIT, DAST) and brief intervention (SBI) services; greater than 30 minutes
99411-99412 Preventive medicine group counseling
S9443 Lactation classes, nonphysician provider, per session Preventive for female only. Update for women's preventive health care guidelines as a part of the Affordable Care Act (Health Care Reform).
CONTRACEPTIVE METHODS AND COUNSELING (Female members only)
11976 Removal, implantable contraceptive capsules Preventive for female only. Update for women's preventive health care guidelines as a part of the Affordable Care Act (Health Care Reform).
11981 Insertion, non-biodegradable drug delivery implant Preventive for female only. Update for women's preventive health care guidelines as a part of the Affordable Care Act (Health Care Reform).
57170 Diaphragm or cervical cap fitting with instructions Preventive for female only. Update for women's preventive health care guidelines as a part of the Affordable Care Act (Health Care Reform).
58300 Insertion of intrauterine device (IUD) Preventive for female only. Update for women's preventive health care guidelines as a part of the Affordable Care Act (Health Care Reform).
58301 Removal of intrauterine device (IUD) Preventive for female only. Update for women's preventive health care guidelines as a part of the Affordable Care Act (Health Care Reform).
58565 Hysteroscopy, surgical; with bilateral fallopian tube cannulation to induce occlusion by placement of permanent implants Preventive for female only. Update for women's preventive health care guidelines as a part of the Affordable Care Act (Health Care Reform).
58600 Ligation or transection of fallopian tube(s), abdominal or vaginal approach, unilateral or bilateral Preventive for female only. Update for women's preventive health care guidelines as a part of the Affordable Care Act (Health Care Reform).
58605 Ligation or transection of fallopian tube(s), abdominal or vaginal approach, postpartum, unilateral or bilateral, during same hospitalization (separate procedure) Preventive for female only. Update for women's preventive health care guidelines as a part of the Affordable Care Act (Health Care Reform).
58611 Ligation or transection of fallopian tube(s) when done at the time of cesarean delivery or intra-abdominal surgery (not a separate procedure) (List separately in addition to code for primary procedure Preventive for female only. Update for women's preventive health care guidelines as a part of the Affordable Care Act (Health Care Reform).
58615 Occlusion of fallopian tube(s) by device (eg, band, clip, Falope ring) vaginal or suprapubic approach Preventive for female only. Update for women's preventive health care guidelines as a part of the Affordable Care Act (Health Care Reform).
58670 Laparoscopy, surgical; with fulguration of oviducts (with or without transection) Preventive for female only. Update for women's preventive health care guidelines as a part of the Affordable Care Act (Health Care Reform).
58671 Laparoscopy, surgical; with occlusion of oviducts by device (eg, band, clip, or Falope ring) Preventive for female only. Update for women's preventive health care guidelines as a part of the Affordable Care Act (Health Care Reform).
A4261 Cervical cap for contraceptive use Preventive for female only. Update for women's preventive health care guidelines as a part of the Affordable Care Act (Health Care Reform).
A4264 Permanent implantable contraceptive intratubal occlusion device(s) and delivery system Preventive for female only. Update for women's preventive health care guidelines as a part of the Affordable Care Act (Health Care Reform).
A4266 Diaphragm for contraceptive use Preventive for female only. Update for women's preventive health care guidelines as a part of the Affordable Care Act (Health Care Reform).
A4268 Contraceptive supply, condom, female, each Preventive for female only. Update for women's preventive health care guidelines as a part of the Affordable Care Act (Health Care Reform).
A4269 Contraceptive supply, spermicide (e.g., foam, gel), each Preventive for female only. Update for women's preventive health care guidelines as a part of the Affordable Care Act (Health Care Reform).
J1050 Injection, medroxyprogesterone acetate, 1 mg Preventive for female only. Update for women's preventive health care guidelines as a part of the Affordable Care Act (Health Care Reform).
J7300 Intrauterine copper contraceptive Preventive for female only. Update for women's preventive health care guidelines as a part of the Affordable Care Act (Health Care Reform).
J7301 Levonorgestrel-releasing intrauterine contraceptive system , 13.5 mg Preventive for female only. Update for women's preventive health care guidelines as a part of the Affordable Care Act (Health Care Reform).
J7302 Levonorgestrel-releasing intrauterine contraceptive system, 52 mg Preventive for female only. Update for women's preventive health care guidelines as a part of the Affordable Care Act (Health Care Reform).
J7303 Contraceptive supply, hormone containing vaginal ring, each Preventive for female only. Update for women's preventive health care guidelines as a part of the Affordable Care Act (Health Care Reform).
J7304 Contraceptive supply, hormone containing patch, each Preventive for female only. Update for women's preventive health care guidelines as a part of the Affordable Care Act (Health Care Reform).
J7306 Levonorgestrel (contraceptive) implant system, including implants and supplies Preventive for female only. Update for women's preventive health care guidelines as a part of the Affordable Care Act (Health Care Reform).
J7307 Etonogestrel (contraceptive) implant system, including implant and supplies Preventive for female only. Update for women's preventive health care guidelines as a part of the Affordable Care Act (Health Care Reform).
DURABLE MEDICAL SERVICES AND SUPPLIES
A4281 Tubing for breast pump, replacement Preventive for female only. Update for women's preventive health care guidelines as a part of the Affordable Care Act (Health Care Reform).
A4282 Adapter for breast pump, replacement Preventive for female only. Update for women's preventive health care guidelines as a part of the Affordable Care Act (Health Care Reform).
A4283 Cap for breast pump bottle, replacement Preventive for female only. Update for women's preventive health care guidelines as a part of the Affordable Care Act (Health Care Reform).
A4284 Breast shield and splash protector for use with breast pump, replacement Preventive for female only. Update for women's preventive health care guidelines as a part of the Affordable Care Act (Health Care Reform).
A4285 Polycarbonate bottle for use with breast pump, replacement Preventive for female only. Update for women's preventive health care guidelines as a part of the Affordable Care Act (Health Care Reform).
A4286 Locking ring for breast pump, replacement Preventive for female only. Update for women's preventive health care guidelines as a part of the Affordable Care Act (Health Care Reform).
E0602 Breast pump, manual, any type Preventive for female only. Update for women's preventive health care guidelines as a part of the Affordable Care Act (Health Care Reform).
E0603 Breast pump, electric (AC and/or DC), any type Preventive for female only. Update for women's preventive health care guidelines as a part of the Affordable Care Act (Health Care Reform).

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Last modified: 5/13/2014
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