UHC Community Plan Will Not Pay Screening nor Counseling Codes with a Preventative Medicine Code

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.