So, please don't bill a screening or a counseling code with a preventative medicine code for UHC Community Plan. You will have to do it again on a different date of service to get paid for it.
Specifically, this includes both initial and periodic preventative medicine evaluation codes (99381-99387, 99391-99397)
The screening services that would get denied are:
- Alcohol Screenings (G0442)
- Depression Screenings (G0444)
- Cervical or vaginal cancer screenings; pelvic and clinical breast examination (G0101)
- Prostate cancer screenings; digital rectal examination (G0102)
- Pap Smears (Q0091)
The counseling services that would get denied are:
- Preventative Medicine Counseling (99401-99404)
- Tobacco Cessation Counseling (99406-99407)
- STI Counseling (G0445)
- Behavioral Therapy for Cardiovascular Disease (G0446)
- Obesity Counseling (G0447,G0473)
- Alcohol/Substance Screening & Intervention (99408-99412,G0396,G0397,G0443,T1006)
- Lung Cancer Screenings (G0296)
- Nutritional Counseling (S9470)
- Family Training (T1027)
There are a few NJ state exceptions to this rule. Per state regulations, counseling codes 99406-99409 and G0396-G0937 are allowable when billed with a preventative medicine code.
Please feel to reach out if you have any questions.