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Preventive Services Coding Under Health Care Reform

The Patient Protection and Affordable Care Act (PPACA) and the Health Care and Education Reconciliation Act of 2010 (HCERA) have designated certain clinical services as preventive benefits.  When provided by an in-network provider, these services are available at no cost to eligible members who are enrolled in non-grandfathered health plans.  

In an effort to ensure that our members receive the most out of their benefits for these services, we’ve developed a guide that outlines the various preventive care services in question.  This guide will provide you with the correct coding, CPT codes, HCPCs codes, diagnosis codes, information regarding the appropriate use of the codes, as well as any related explanatory comments for each service.

The Health Care Reform Preventive Services Coding Guide will be released to providers via Blue eSM under the “Related Links” section on June 17, 2013.  As new national recommendations are published, we will update the online guide accordingly. 

Below are the effective dates for the service categories included in the preventive services guide.  Please note that these effective dates apply to our members’ benefits for these services on or after their respective plan renewal date, which may be after the dates listed below:

  • September 23, 2010:   Basic mandates from USPSTF, Bright Futures and Centers for Disease Control and Prevention immunization schedules
  • August 1, 2012:  Women’s health-related services
  • April 1, 2013:  New mandates for skin cancer counseling and cervical cancer
  • June 1, 2013:  New mandates for obesity screenings and fall prevention
  • July 1, 2013:  BRCA test and contraceptive device removal

If you need any assistance accessing this coding information, please contact the Provider Blue LineSM at 1.800.214.4844.