Education
Preventive Care Visits
Preventive health visits can be scheduled every calendar year for all Buckeye Health Plan members.
- Allows members and providers to schedule preventive health visits when it is more convenient
- Removes barrier of waiting 365 days from last preventive health visit to schedule a new preventive health visit (for ages 2 and up)
Best Practices
- Consider every visit an opportunity for a preventive visit and an immunization.
- Review patient charts prior to appointments and allow extra time to complete a preventive visit with a sick visit/sport physical or a sick visit with a preventive visit.
- Schedule the next preventive health visit during check out.
- Collaborate with your EHR vendor to incorporate pop-up alerts for preventive services.
- Send reminder notifications via letter, call, text, or mobile app to your attributed/assigned patients to notify them of the need to schedule an appointment and/or a reminder to attend their scheduled appointment.
- Do not forget about the patients that have not yet been seen. These patients either chose your office or were assigned to it.
- Medicaid patients generally need 48 hours to arrange for transportation. So, send reminders 48 to 72 hours prior to appointment.
Points To Keep in Mind
- If it is the first time a patient will be seen in your office, only one of the two billed visits can be billed as a new patient visit.
- Ex: A new patient is seen for a preventive health visit. During the preventive health visit, a patient is identified as being sick; so, both a preventive health check and a sick visit are appropriately completed. The preventive health visit is billed as a new patient visit and the sick visit completed with the scheduled preventive health visit is billed with the appropriate E&M as an established patient.
- If the provider’s documentation supports services for a preventive health visit and a sick visit (with no overlapping documentation components), then separate reimbursement is both warranted and supported.
- When billing a sick visit on the same day as a preventive health visit, bill the appropriate E&M code (ie 99201-99215) with modifier-25 and preventive code (ie 99381-99397).
- Preventive health visits for infants and school age children must be in person.
For additional information see our HEDIS Tip Booklet.
When a patient is seen in the office for a preventive visit, as a new or established patient, providers can bill that diagnostic exam as an E&M-25. Providers should reference the most up-to-date sources of professional coding guidance for valid CPT/HCPCS codes.
To receive payment, follow the billing guidelines below taken from the HEDIS Tip Booklet
Description | Codes **ICD-10 code cohorts listed
|
---|---|
Well-Care Visits** | CPT: 99381-99385, 99391-99395, 99461 |
HCPCS: G0438, G0439, S0302 | |
ICD-10: Z00.00, Z00.01, Z00.110, Z00.111, Z00.121, Z00.129, Z00.2, Z00.3, Z02.5, Z76.1, Z76.2 | |
Modifier: 25 | |
|
|
Well-Care Visits** | CPT: 99381-99385, 99391-99395, 99461 |
HCPCS: G0438, G0439, S0302, S0610, S0612, S0613 | |
ICD-10: Z00.00, Z00.01, Z00.110, Z00.111, Z00.121, Z00.129, Z00.2, Z00.3, Z01.411, Z01.419, Z02.5, Z76.1, Z76.2 | |
Modifier: 25 | |
|
|
Ambulatory Visits** | CPT: 99201-99205, 99211-99215, 99241-99245,99341-99350, 99381-99387, 99345, 99347-99350, 99381-99387, 99391-99397, 99401-99404, 99411-99412, 99483 |
HCPCS: G0402, G0438, G0439, G0463, T1015 | |
UBREV: 0510-0517, 0519-0523, 0526-0529, 0982-0983 | |
ICD-10: Z00.00, Z00.01, Z00.121, Z00.129, Z00.3, Z00.5, Z00.8, Z02.0-Z02.6, Z02.71, Z02.79, Z02.81-Z02.83, Z02.89, Z02.9, Z76.1, Z76.2 | |
Other Ambulatory Visits with or without Telehealth | CPT: 92002, 92004, 92012, 92014, 99304-99310, 99315, 99316, 99318, 99324-99328, 99334-99337 |
HCPCS: S0620, S0621 | |
UBREV: 0524-0525 | |
Telephone Visit | CPT: 98966-98968, 99441-99443 |
Online Assessment | CPT: 98969-98972, 99421-99423, 99444, 99457, 99458 |
HCPCS: G0071, G2010, G2012, G2061-G2063, G2250-G2252 | |
Modifiers | Telehealth: 96, GT |