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Screening for Cervical Cancer with Human Papillomavirus (HPV) Tests

Human Papillomavirus 

The lab analyst performs the technical steps to detect human papillomavirus through nucleic acid detection and the Nucleic acid probes permit identification of microorganisms based on their DNA or RNA. 

The Nucleic acid quantitation allows assessment of treatment response and the Quantitation refers to measuring the exact amount of a substance. The lab analyst performs this procedure for detection of high risk types of human papillomavirus.

HCPCS/CPT Codes

  • G0476 – Infectious agent detection by nucleic acid (DNA or RNA); human papillomavirus (HPV), high-risk types (eg, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68) for cervical cancer screening, must be performed in addition to pap test 

ICD-10 Codes

The specified below ICD codes are covered for CPT G0476 but may not be limited and some private payers having specific guidelines.

  • B97.7 Papillomavirus as the cause of diseases classified elsewhere
  • R85.81 Anal high risk human papillomavirus (HPV) DNA test positive
  • R85.82 Anal low risk human papillomavirus (HPV) DNA test positive
  • R87.810 Cervical high risk human papillomavirus (HPV) DNA test positive
  • R87.811 Vaginal high risk human papillomavirus (HPV) DNA test positive
  • R87.820 Cervical low risk human papillomavirus (HPV) DNA test positive
  • R87.821 Vaginal low risk human papillomavirus (HPV) DNA test positive
  • Z01.411 Encounter for gynecological examination (general) (routine) with abnormal findings
  • Z01.419 Encounter for gynecological examination (general) (routine) without abnormal findings
  • Z01.42 Encounter for cervical smear to confirm findings of recent normal smear following initial abnormal smear
  • Z11.51 Encounter for screening for human papillomavirus (HPV)
  • Z86.002 Personal history of in-situ neoplasm of other and unspecified genital organs

Who Is Covered

  • All asymptomatic female Medicare beneficiaries aged 30 to 65 years

Frequency

  • Once every 5 years

Medicare Beneficiary Pays

  • Co-payment/coinsurance waived
  • Deductible waived

Intensive Behavioral Therapy (IBT) - CPT G0446

Intensive Behavioral Therapy (IBT) for Cardiovascular Disease (CVD)

  • Also known as a CVD risk reduction visit

HCPCS/CPT Codes

  • G0446 – Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes

Covered ICD Codes

The specified below ICD  codes are covered for CPT G0446 but may not be limited and some private payers having specific guidelines.

  • F53.0    Postpartum depression
  • F53.1    Puerperal psychosis 
  • F68.A    Factitious disorder imposed on another
  • I01.0 Acute rheumatic pericarditis
  • I01.1 Acute rheumatic endocarditis
  • I01.2 Acute rheumatic myocarditis
  • I01.8 Other acute rheumatic heart disease
  • I01.9 Acute rheumatic heart disease, unspecified
  • I02.0 Rheumatic chorea with heart involvement
  • I02.9 Rheumatic chorea without heart involvement
  • I05.0 Rheumatic mitral stenosis
  • I05.1 Rheumatic mitral insufficiency
  • I05.2 Rheumatic mitral stenosis with insufficiency
  • I05.8 Other rheumatic mitral valve diseases
  • I05.9 Rheumatic mitral valve disease, unspecified
  • I06.0 Rheumatic aortic stenosis
  • I06.1 Rheumatic aortic insufficiency
  • I06.2 Rheumatic aortic stenosis with insufficiency
  • I06.8 Other rheumatic aortic valve diseases
  • I06.9 Rheumatic aortic valve disease, unspecified
  • I07.0 Rheumatic tricuspid stenosis
  • I07.1 Rheumatic tricuspid insufficiency
  • I07.2 Rheumatic tricuspid stenosis and insufficiency
  • I07.8 Other rheumatic tricuspid valve diseases
  • I07.9 Rheumatic tricuspid valve disease, unspecified
  • I08.0 Rheumatic disorders of both mitral and aortic valves
  • I08.1 Rheumatic disorders of both mitral and tricuspid valves
  • I08.2 Rheumatic disorders of both aortic and tricuspid valves
  • I08.3 Combined rheumatic disorders of mitral, aortic and tricuspid valves
  • I08.8 Other rheumatic multiple valve diseases
  • I08.9 Rheumatic multiple valve disease, unspecified
  • I09.0 Rheumatic myocarditis
  • I09.1 Rheumatic diseases of endocardium, valve unspecified
  • I09.2 Chronic rheumatic pericarditis
  • I09.81 Rheumatic heart failure
  • I09.89 Other specified rheumatic heart diseases
  • I09.9 Rheumatic heart disease, unspecified
  • I10         Essential (primary) hypertension
  • I11.0 Hypertensive heart disease with heart failure
  • I11.9 Hypertensive heart disease without heart failure
  • I12.0 Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease
  • I12.9 Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
  • I13.0 Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
  • I13.10 Hypertensive heart and chronic kidney disease without heart failure, with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
  • I13.11 Hypertensive heart and chronic kidney disease without heart failure, with stage 5 chronic kidney disease, or end stage renal disease
  • I13.2 Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease
  • I15.0 Reno vascular hypertension
  • I15.1 Hypertension secondary to other renal disorders
  • I15.2 Hypertension secondary to endocrine disorders
  • I15.8 Other secondary hypertension
  • I15.9 Secondary hypertension, unspecified
  • I16.0 Hypertensive urgency
  • I16.1 Hypertensive emergency
  • I16.9 Hypertensive crisis, unspecified
  • I20.0 Unstable angina
  • I20.1 Angina pectoris with documented spasm
  • I20.8 Other forms of angina pectoris
  • I20.9 Angina pectoris, unspecified
  • I21.01 ST elevation (STEMI) myocardial infarction involving left main coronary artery
  • I21.02 ST elevation (STEMI) myocardial infarction involving left anterior descending coronary artery
  • I21.09 ST elevation (STEMI) myocardial infarction involving other coronary artery of anterior wall
  • I21.11 ST elevation (STEMI) myocardial infarction involving right coronary artery
  • I21.19 ST elevation (STEMI) myocardial infarction involving other coronary artery of inferior wall
  • I21.21 ST elevation (STEMI) myocardial infarction involving left circumflex coronary artery
  • I21.29 ST elevation (STEMI) myocardial infarction involving other sites
  • I21.3 ST elevation (STEMI) myocardial infarction of unspecified site
  • I21.4 Non-ST elevation (NSTEMI) myocardial infarction
  • I22.0 Subsequent ST elevation (STEMI) myocardial infarction of anterior wall
  • I22.1 Subsequent ST elevation (STEMI) myocardial infarction of inferior wall
  • I22.2 Subsequent non-ST elevation (NSTEMI) myocardial infarction
  • I22.8 Subsequent ST elevation (STEMI) myocardial infarction of other sites
  • I22.9 Subsequent ST elevation (STEMI) myocardial infarction of unspecified site
  • I23.0 Hemopericardium as current complication following acute myocardial infarction
  • I23.1 Atrial septal defect as current complication following acute myocardial infarction
  • I23.2 Ventricular septal defect as current complication following acute myocardial infarction
  • I23.3 Rupture of cardiac wall without hemopericardium as current complication following acute myocardial infarction
  • I23.4 Rupture of chordae tendineae as current complication following acute myocardial infarction
  • I23.5 Rupture of papillary muscle as current complication following acute myocardial infarction
  • I23.6 Thrombosis of atrium, auricular appendage, and ventricle as current complications following acute myocardial infarction
  • I23.7 Postinfarction angina
  • I23.8 Other current complications following acute myocardial infarction
  • I24.0 Acute coronary thrombosis not resulting in myocardial infarction
  • I24.1 Dressler's syndrome
  • I24.8 Other forms of acute ischemic heart disease
  • I24.9 Acute ischemic heart disease, unspecified
  • I25.10 Atherosclerotic heart disease of native coronary artery without angina pectoris
  • I25.110 Atherosclerotic heart disease of native coronary artery with unstable angina pectoris
  • I25.111 Atherosclerotic heart disease of native coronary artery with angina pectoris with documented spasm
  • I25.118 Atherosclerotic heart disease of native coronary artery with other forms of angina pectoris
  • I25.119 Atherosclerotic heart disease of native coronary artery with unspecified angina pectoris
  • I25.2 Old myocardial infarction
  • I25.3 Aneurysm of heart
  • I25.41 Coronary artery aneurysm
  • I25.42 Coronary artery dissection
  • I25.5 Ischemic cardiomyopathy
  • I25.6 Silent myocardial ischemia
  • I25.700 Atherosclerosis of coronary artery bypass graft(s), unspecified, with unstable angina pectoris
  • I25.701 Atherosclerosis of coronary artery bypass graft(s), unspecified, with angina pectoris with documented spasm
  • I25.708 Atherosclerosis of coronary artery bypass graft(s), unspecified, with other forms of angina pectoris
  • I25.709 Atherosclerosis of coronary artery bypass graft(s), unspecified, with unspecified angina pectoris
  • I25.710 Atherosclerosis of autologous vein coronary artery bypass graft(s) with unstable angina pectoris
  • I25.711 Atherosclerosis of autologous vein coronary artery bypass graft(s) with angina pectoris with documented spasm
  • I25.718 Atherosclerosis of autologous vein coronary artery bypass graft(s) with other forms of angina pectoris
  • I25.719 Atherosclerosis of autologous vein coronary artery bypass graft(s) with unspecified angina pectoris
  • I25.720 Atherosclerosis of autologous artery coronary artery bypass graft(s) with unstable angina pectoris
  • I25.721 Atherosclerosis of autologous artery coronary artery bypass graft(s) with angina pectoris with documented spasm
  • I25.728 Atherosclerosis of autologous artery coronary artery bypass graft(s) with other forms of angina pectoris
  • I25.729 Atherosclerosis of autologous artery coronary artery bypass graft(s) with unspecified angina pectoris
  • I25.730 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with unstable angina pectoris
  • I25.731 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with angina pectoris with documented spasm
  • I25.738 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with other forms of angina pectoris
  • I25.739 Atherosclerosis of nonautologous biological coronary artery bypass graft(s) with unspecified angina pectoris
  • I25.750 Atherosclerosis of native coronary artery of transplanted heart with unstable angina
  • I25.751 Atherosclerosis of native coronary artery of transplanted heart with angina pectoris with documented spasm
  • I25.758 Atherosclerosis of native coronary artery of transplanted heart with other forms of angina pectoris
  • I25.759 Atherosclerosis of native coronary artery of transplanted heart with unspecified angina pectoris
  • I25.760 Atherosclerosis of bypass graft of coronary artery of transplanted heart with unstable angina
  • I25.761 Atherosclerosis of bypass graft of coronary artery of transplanted heart with angina pectoris with documented spasm
  • I25.768 Atherosclerosis of bypass graft of coronary artery of transplanted heart with other forms of angina pectoris
  • I25.769 Atherosclerosis of bypass graft of coronary artery of transplanted heart with unspecified angina pectoris
  • I25.790 Atherosclerosis of other coronary artery bypass graft(s) with unstable angina pectoris
  • I25.791 Atherosclerosis of other coronary artery bypass graft(s) with angina pectoris with documented spasm
  • I25.798 Atherosclerosis of other coronary artery bypass graft(s) with other forms of angina pectoris
  • I25.799 Atherosclerosis of other coronary artery bypass graft(s) with unspecified angina pectoris
  • I25.810 Atherosclerosis of coronary artery bypass graft(s) without angina pectoris
  • I25.811 Atherosclerosis of native coronary artery of transplanted heart without angina pectoris
  • I25.812 Atherosclerosis of bypass graft of coronary artery of transplanted heart without angina pectoris
  • I25.82 Chronic total occlusion of coronary artery
  • I25.83 Coronary atherosclerosis due to lipid rich plaque
  • I25.84 Coronary atherosclerosis due to calcified coronary lesion
  • I25.89 Other forms of chronic ischemic heart disease
  • I25.9 Chronic ischemic heart disease, unspecified
  • I26.01 Septic pulmonary embolism with acute cor pulmonale
  • I26.02 Saddle embolus of pulmonary artery with acute cor pulmonale
  • I26.09 Other pulmonary embolism with acute cor pulmonale
  • I26.90 Septic pulmonary embolism without acute cor pulmonale
  • I26.92 Saddle embolus of pulmonary artery without acute cor pulmonale
  • I26.93 Single subsegmental pulmonary embolism without acute cor pulmonale
  • I26.94 Multiple subsegmental pulmonary emboli without acute cor pulmonale
  • I26.99 Other pulmonary embolism without acute cor pulmonale
  • I27.0 Primary pulmonary hypertension
  • I27.1 Kyphoscoliotic heart disease
  • I27.81 Cor pulmonale (chronic)
  • I27.82 Chronic pulmonary embolism
  • I27.89 Other specified pulmonary heart diseases
  • I27.9 Pulmonary heart disease, unspecified
  • I28.0 Arteriovenous fistula of pulmonary vessels
  • I28.1 Aneurysm of pulmonary artery
  • I28.8 Other diseases of pulmonary vessels
  • I28.9 Disease of pulmonary vessels, unspecified
  • I30.0 Acute nonspecific idiopathic pericarditis
  • I30.1 Infective pericarditis
  • I30.8 Other forms of acute pericarditis
  • I30.9 Acute pericarditis, unspecified
  • I31.0 Chronic adhesive pericarditis
  • I31.1 Chronic constrictive pericarditis
  • I31.2 Hemopericardium, not elsewhere classified
  • I31.3 Pericardial effusion (noninflammatory)
  • I31.4 Cardiac tamponade
  • I31.8 Other specified diseases of pericardium
  • I31.9 Disease of pericardium, unspecified
  • I32         Pericarditis in diseases classified elsewhere
  • I33.0 Acute and subacute infective endocarditis
  • I33.9 Acute and subacute endocarditis, unspecified 
  • I34.0 Nonrheumatic mitral (valve) insufficiency
  • I34.1 Nonrheumatic mitral (valve) prolapse
  • I34.2 Nonrheumatic mitral (valve) stenosis
  • I34.8 Other nonrheumatic mitral valve disorders
  • I34.9 Nonrheumatic mitral valve disorder, unspecified
  • I35.0 Nonrheumatic aortic (valve) stenosis
  • I35.1 Nonrheumatic aortic (valve) insufficiency
  • I35.2 Nonrheumatic aortic (valve) stenosis with insufficiency
  • I35.8 Other nonrheumatic aortic valve disorders
  • I35.9 Nonrheumatic aortic valve disorder, unspecified
  • I36.0 Nonrheumatic tricuspid (valve) stenosis
  • I36.1 Nonrheumatic tricuspid (valve) insufficiency
  • I36.2 Nonrheumatic tricuspid (valve) stenosis with insufficiency
  • I36.8 Other nonrheumatic tricuspid valve disorders
  • I36.9 Nonrheumatic tricuspid valve disorder, unspecified
  • I37.0 Nonrheumatic pulmonary valve stenosis
  • I37.1 Nonrheumatic pulmonary valve insufficiency
  • I37.2 Nonrheumatic pulmonary valve stenosis with insufficiency
  • I37.8 Other nonrheumatic pulmonary valve disorders
  • I37.9 Nonrheumatic pulmonary valve disorder, unspecified
  • I38         Endocarditis, valve unspecified
  • I39         Endocarditis and heart valve disorders in diseases classified elsewhere
  • I40.0 Infective myocarditis
  • I40.1 Isolated myocarditis
  • I40.8 Other acute myocarditis
  • I40.9 Acute myocarditis, unspecified
  • I41         Myocarditis in diseases classified elsewhere
  • I42.0 Dilated cardiomyopathy
  • I42.1 Obstructive hypertrophic cardiomyopathy
  • I42.2 Other hypertrophic cardiomyopathy
  • I42.3 Endomyocardial (eosinophilic) disease
  • I42.4 Endocardial fibroelastosis
  • I42.5 Other restrictive cardiomyopathy
  • I42.6 Alcoholic cardiomyopathy
  • I42.7 Cardiomyopathy due to drug and external agent
  • I42.8 Other cardiomyopathies
  • I42.9 Cardiomyopathy, unspecified
  • I43         Cardiomyopathy in diseases classified elsewhere
  • I44.0 Atrioventricular block, first degree
  • I44.1 Atrioventricular block, second degree
  • I44.2 Atrioventricular block, complete
  • I44.30 Unspecified atrioventricular block
  • I44.39 Other atrioventricular block
  • I44.4 Left anterior fascicular block
  • I44.5 Left posterior fascicular block
  • I44.60 Unspecified fascicular block
  • I44.69 Other fascicular block
  • I44.7 Left bundle-branch block, unspecified
  • I45.0 Right fascicular block
  • I45.10 Unspecified right bundle-branch block
  • I45.19 Other right bundle-branch block
  • I45.2 Bifascicular block
  • I45.3 Trifascicular block
  • I45.4 Nonspecific intraventricular block
  • I45.5 Other specified heart block
  • I45.6 Pre-excitation syndrome
  • I45.81 Long QT syndrome
  • I45.89 Other specified conduction disorders
  • I45.9 Conduction disorder, unspecified
  • I46.2 Cardiac arrest due to underlying cardiac condition
  • I46.8 Cardiac arrest due to other underlying condition
  • I46.9 Cardiac arrest, cause unspecified
  • I47.0 Re-entry ventricular arrhythmia
  • I47.1 Supraventricular tachycardia
  • I47.2 Ventricular tachycardia
  • I47.9 Paroxysmal tachycardia, unspecified
  • I48.0 Paroxysmal atrial fibrillation
  • I48.11 Longstanding persistent atrial fibrillation
  • I48.19 Other persistent atrial fibrillation
  • I48.20 Chronic atrial fibrillation, unspecified
  • I48.21 Permanent atrial fibrillation
  • I48.3 Typical atrial flutter
  • I48.4 Atypical atrial flutter
  • I48.91 Unspecified atrial fibrillation
  • I48.92 Unspecified atrial flutter
  • I49.01 Ventricular fibrillation
  • I49.02 Ventricular flutter
  • I49.1 Atrial premature depolarization
  • I49.2 Junctional premature depolarization
  • I49.3 Ventricular premature depolarization
  • I49.40 Unspecified premature depolarization
  • I49.49 Other premature depolarization
  • I49.5 Sick sinus syndrome
  • I49.8 Other specified cardiac arrhythmias
  • I49.9 Cardiac arrhythmia, unspecified
  • I50.1 Left ventricular failure, unspecified
  • I50.20 Unspecified systolic (congestive) heart failure
  • I50.21 Acute systolic (congestive) heart failure
  • I50.22 Chronic systolic (congestive) heart failure
  • I50.23 Acute on chronic systolic (congestive) heart failure
  • I50.30 Unspecified diastolic (congestive) heart failure
  • I50.31 Acute diastolic (congestive) heart failure
  • I50.32 Chronic diastolic (congestive) heart failure
  • I50.33 Acute on chronic diastolic (congestive) heart failure
  • I50.40 Unspecified combined systolic (congestive) and diastolic (congestive) heart failure
  • I50.41 Acute combined systolic (congestive) and diastolic (congestive) heart failure
  • I50.42 Chronic combined systolic (congestive) and diastolic (congestive) heart failure
  • I50.43 Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure
  • I50.9 Heart failure, unspecified
  • I51.0 Cardiac septal defect, acquired
  • I51.1 Rupture of chordae tendineae, not elsewhere classified
  • I51.2 Rupture of papillary muscle, not elsewhere classified
  • I51.3 Intracardiac thrombosis, not elsewhere classified
  • I51.4 Myocarditis, unspecified
  • I51.5 Myocardial degeneration
  • I51.7 Cardiomegaly
  • I51.81 Takotsubo syndrome
  • I51.89 Other ill-defined heart diseases
  • I51.9 Heart disease, unspecified
  • I52         Other heart disorders in diseases classified elsewhere
  • Z13.30 Encounter for screening examination for mental health and behavioral disorders, unspecified
  • Z13.31 Encounter for screening for depression
  • Z13.32 Encounter for screening for maternal depression
  • Z13.39 Encounter for screening examination for other mental health and behavioral disorders

Who Is Covered

All Medicare beneficiaries covered when following criteria are met,

  • Competent and alert at the time counseling is provided
  • Furnished counseling by a qualified primary care physician or other primary care practitioner and in a primary care setting

Frequency

  • Annually for covered Medicare beneficiaries

Medicare Beneficiary Pays

  • Co-payment/coinsurance waived
  • Deductible waived

Intensive Behavioral Therapy (IBT) for Obesity

HCPCS/CPT Codes

  • G0447 – Face-to-face behavioral counseling for obesity, 15 minutes
  • G0473 – Face-to-face behavioral counseling for obesity, group (2–10), 30 minutes

Covered ICD-10 Codes for CPT G0447 & G0473

The specified below ICD codes are covered for CPT G0472 and may not be limited and some private payers have own specific guidelines,

  • Z68.30 - Body mass index [BMI] 30.0-30.9, adult
  • Z68.31  -Body mass index [BMI] 31.0-31.9, adult
  • Z68.32 - Body mass index [BMI] 32.0-32.9, adult
  • Z68.33 - Body mass index [BMI] 33.0-33.9, adult
  • Z68.34 - Body mass index [BMI] 34.0-34.9, adult
  • Z68.35 - Body mass index [BMI] 35.0-35.9, adult
  • Z68.36 - Body mass index [BMI] 36.0-36.9, adult
  • Z68.37 - Body mass index [BMI] 37.0-37.9, adult
  • Z68.38 - Body mass index [BMI] 38.0-38.9, adult
  • Z68.39 - Body mass index [BMI] 39.0-39.9, adult
  • Z68.41 - Body mass index [BMI] 40.0-44.9, adult
  • Z68.42 - Body mass index [BMI] 45.0-49.9, adult
  • Z68.43 - Body mass index [BMI] 50.0-59.9, adult
  • Z68.44 - Body mass index [BMI] 60.0-69.9, adult
  • Z68.45 - Body mass index [BMI] 70 or greater, adult
Require primary ICD Codes for above diagnosis,
  • E66.9 - Obesity, unspecified
  • E66.8 - Other obesity
  • E66.3 - Overweight
  • E66.2 - Morbid (severe) obesity with alveolar hypoventilation
  • E66.1 - Drug-induced obesity
  • E66.09 - Other obesity due to excess calories
  • E66.01 - Morbid (severe) obesity due to excess calories

Who Is Covered

The Medicare beneficiaries requires the following information to meat the medical necessity 

  • Obesity (Body Mass Index [BMI] ≥ 30 kilograms [kg] per meter squared)
  • Competent and alert at the time counseling is provided
  • Counseling furnished by a qualified primary care physician or other primary care practitioner in a primary care setting

Frequency

  • First month: one face-to-face visit every week
  • Months 2–6: one face-to-face visit every other week
  • Months 7–12: one face-to-face visit every month if certain requirements are met.

At the 6-month visit, a reassessment of obesity and a determination of the amount of weight loss must be performed.

To be eligible for additional face-to-face visits occurring once a month for an additional 6 months, Medicare beneficiaries must have lost at least 3 kg.

For Medicare beneficiaries who do not achieve a weight loss of at least 3 kg during the first 6 months, a reassessment of their readiness to change and BMI is appropriate after an additional 6-month period.

Medicare Beneficiary Pays

  • Co-payment/coinsurance waived
  • Deductible waived

Admission Type with Abbreviation - Place Of Service (POS)

PLACE OF SERVICE - PATIENT TYPES 

  • IN - INPATIENT (POS - 21) - A patient who is assigned a room and bed and receives automatic room/bed charges. 
  • INO - OBSERVATION (POS - 22) - An outpatient who is assigned a room and bed, but does not receive an automatic room/bed charge. 
  • OBS - OBSERVATION (POS - 22) - An outpatient who is assigned a room and bed, but does not receive an automatic room/bed charge. 
  • TELE - TELEMETRY (POS - 22) - An outpatient who is assigned a room and bed, but does not receive an automatic room/bed charge and continuous monitoring. 
  • SDC - SURGICAL DAY CARE (POS - 22) - A patient who visits the hospital for outpatient surgery. 
  • SDS - SAME DAY SURGERY (POS - 22) - A patient who visits the hospital for outpatient surgery. 
  • RCR - RECURRING (POS - 22) - An outpatient who returns to the hospital more than two times for related treatments (a series patient).
  • ER - EMERGENCY (POS - 23) - An outpatient who comes to the hospital unscheduled and is treated in the emergency room. 
  • CLI - CLINICAL (POS - 11) - Used for outpatient visits (Lab, Radiology, Respiratory Therapy, Same Day Procedure, NST, OB Check). 
    • If the service rendered in Hospital than should be used "POS - 22" 
 

Screening Pelvic Examinations

Screening Pelvic Examinations - Includes a clinical breast examination

HCPCS/CPT Codes

  • G0101 – Cervical or vaginal cancer screening; pelvic and clinical breast examination

Covered ICD Codes for CPT G0101

The specified below ICD codes are covered for CPT G0472 and may not be limited and some private payers have own specific guidelines,

High risk 

  • Z72.51 - High risk heterosexual behavior
  • Z72.52 - High risk homosexual behavior
  • Z72.53 - High risk bisexual behavior
  • Z72.89 - Other problems related to lifestyle
  • Z77.22 - Contact with and (suspected) exposure to environmental tobacco smoke (acute) (chronic)
  • Z77.9 - Other contact with and (suspected) exposures hazardous to health
  • Z91.89 - Other specified personal risk factors, not elsewhere classified

Low risk

  • Z01.411- Encounter for gynecological examination (general) (routine) with abnormal findings
  • Z01.419 - Encounter for gynecological examination (general) (routine) without abnormal findings
  • Z12.4 - Encounter for screening for malignant neoplasm of cervix
  • Z12.72 - Encounter for screening for malignant neoplasm of vagina
  • Z12.79 - Encounter for screening for malignant neoplasm of other genitourinary organs
  • Z12.89 - Encounter for screening for malignant neoplasm of other sites

Who Is Covered

  • All female Medicare beneficiaries

Frequency

  • Annually if at high risk for developing cervical or vaginal cancer or childbearing age with abnormal Pap test within past 3 years
  • Every 2 years for women at normal risk

Medicare Beneficiary Pays

  • Co-payment/coinsurance waived
  • Deductible waived

COVID-19 PHE Extension & Flu & Pneumococcal Vaccines Updates for September 2021

Flu & Pneumococcal Vaccines Updates for September 2021

Flu & Pneumococcal Vaccines are Expanded SNF Enforcement Discretion for Certain Pharmacy Billing effective from 09/20/2021.

CMS exercised enforcement discretion for Skilled Nursing Facility (SNF) consolidated billing provisions related to flu and pneumococcal vaccines. 

This allows Medicare-enrolled immunizers, including pharmacies, to bill directly and get direct reimbursement from the Medicare program (including vaccine administration and product), whether these vaccines are administered at the same time (co-administered) with a COVID-19 vaccine or at different times. 

COVID-19 National Public Health Emergency Extension

The U.S. Department of Health and Human Services has extended the COVID-19 national public health emergency by another 90 days. 

And it was scheduled to end Oct. 17, 2021 and now it has been scheduled through Jan. 15, 2022.

The extension is applicable for following services,

  • Cost share waivers – Testing
  • Cost share waivers – Treatment
  • Cost share waivers – Transportation
  • Cost share waivers – Medicare Advantage Professional Services
  • Telehealth cost share – COVID-19
  • Telehealth cost share – Non-COVID-19
  • Telehealth expansion
  • Timely filing and prescription refills
  • Referrals and provisional credentialing
  • Prior authorization

Hepatitis B Virus (HBV) Vaccine and Administration

HCPCS/CPT Codes

  • 90739 – Hepatitis B vaccine, adult dosage (2 dose schedule), for intramuscular use
  • 90740 – Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (3 dose schedule), for intramuscular use
  • 90743 – Hepatitis B vaccine, adolescent (2 dose schedule), for intramuscular use
  • 90744 – Hepatitis B vaccine, pediatric/adolescent dosage (3 dose schedule), for intramuscular use
  • 90746 – Hepatitis B vaccine, adult dosage (3 dose schedule), for intramuscular use
  • 90747 – Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (4 dose schedule), for intramuscular use
  • G0010 – Administration of Hepatitis B vaccine

Covered ICD-10 Codes for CPT 90739, 90740, 90743, 90744, 90746, 90747

The specified below ICD codes are covered for CPT G0472 and may not be limited and some private payers have own specific guidelines,

  • Z23         Encounter for immunization
  • R74.01 Elevation of levels of liver transaminase levels
  • Z71.84 Encounter for health counseling related to travel

Covered ICD-10 Codes for CPT G0010

The specified below ICD codes are covered for CPT G0472 and may not be limited and some private payers have own specific guidelines,
  • B16.0 Acute hepatitis B with delta-agent with hepatic coma
  • B16.1 Acute hepatitis B with delta-agent without hepatic coma
  • B16.2 Acute hepatitis B without delta-agent with hepatic coma
  • B16.9 Acute hepatitis B without delta-agent and without hepatic coma
  • B17.0 Acute delta-(super) infection of hepatitis B carrier
  • B17.8 Other specified acute viral hepatitis
  • B17.9 Acute viral hepatitis, unspecified
  • B18.0 Chronic viral hepatitis B with delta-agent
  • B18.1 Chronic viral hepatitis B without delta-agent
  • B18.8 Other chronic viral hepatitis
  • B18.9 Chronic viral hepatitis, unspecified
  • B19.10 Unspecified viral hepatitis B without hepatic coma
  • B19.11 Unspecified viral hepatitis B with hepatic coma
  • K73.9 Chronic hepatitis, unspecified
  • K75.2 Nonspecific reactive hepatitis
  • Z28.04 Immunization not carried out because of patient allergy to vaccine or component
  • Z88.7 Allergy status to serum and vaccine

Who Is Covered

  • Certain Medicare beneficiaries at intermediate or high risk for contracting hepatitis B

NOTE: 

Medicare beneficiaries who are currently positive for antibodies for hepatitis B are not eligible for this benefit

Frequency

  • Scheduled dosages required

Medicare Beneficiary Pays

  • Co-payment/coinsurance waived
  • Deductible waived

ICD 10 CM Updates

Telehealth Updates – April 2025 Extension Through September 30, 2025

Telehealth Extended to September 30th, 2025 The National Association of Social Workers (NASW) has received numerous inquiries regarding the ...