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Notification of Medical Policy Revision: CPT 99420

Release Date: September 10, 2012

Blue Cross and Blue Shield of North Carolina (BCBSNC) is modifying its policy for administration and interpretation of health risk assessments when performed in conjunction with evaluation and management services or other related services.  BCBSNC considers the administration and interpretation of a health risk assessment instrument as:  A health risk assessment instrument (99420) is not reimbursed separately. It is considered incidental to the associated evaluation and management services.  99420 should not be used for developmental screening or testing. See BCBSNC policy entitled, Developmental Delay Screening and Testing Guidelines. 

BCBSNC is currently revising our Medical Policy entitled Code Bundling Rules Not Addressed in Claims Check® or Correct Coding Initiative to include guidelines specific to our handling of code 99420.  The revised policy will be available to view on our website http://www.bcbsnc.com/content/services/medical-policy/updates/index.htm  beginning September 18, 2012, and becomes effective November 27, 2012.  Subsequently, claims for services performed on or after November 27, 2012 reported by use of code 99420, and billed in conjunction with evaluation and management or related services will be considered incidental to the associated evaluation and management services with no additional allowance for the administration and interpretation of the health risk assessment.    

As a reminder, bundled or incidental services are not billable to BCBSNC members.

The CPT 2012 Professional Edition defines code 99420 as administration and interpretation of health risk assessment instrument (e.g. health hazard appraisal). BCBSNC's Medical Policy entitled Code Bundling Rules Not Addressed in Claim Check® or Correct Coding Initiative for CPT code 99420 will be updated accordingly and available at:

http://www.bcbsnc.com/assets/services/public/pdfs/medicalpolicy/code_bundling_rules_not_addressed_in_claim_check.pdf

If you have any questions, please contact BCBSNC Customer Service via the Provider Blue LineSM at 1.800.214.4844.