Medical Coding Rights

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 ne

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 Co

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 Cover

Third Dose of Moderna COVID-19 vaccine CPT code has been released, 0013A - Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5 mL dosage; third dose Other  administration codes are,  0011A -   Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage; first dose 0012A -  Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage; second dose Vaccine CPT Code 91301-  Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, pr

HCPCS/CPT Codes G0472 – Hepatitis C antibody screening, for individual at high risk and other covered indication(s) Covered ICD-10 Codes The specified below ICD codes are covered for CPT G0472 and may not be limited and some private payers have own specific guidelines, B17.10 Acute hepatitis C without hepatic coma B17.11 Acute hepatitis C with hepatic coma B18.2 Chronic viral hepatitis C B18.8 Other chronic viral hepatitis B18.9 Chronic viral hepatitis, unspecified B19.20 Unspecified viral hepatitis C without hepatic coma B19.21 Unspecified viral hepatitis C with hepatic coma B19.9 Unspecified viral hepatitis without hepatic coma B25.1 Cytomegaloviral hepatitis F19.20 Other psychoactive substance dependence, uncomplicated O98.411 Viral hepatitis complicating pregnancy, first trimester O98.412 Viral hepatitis complicating pregnancy, second trimester O98.413 Viral hepatitis complicating pregnancy, third trimester O98.419 Viral hepatitis complicating pregnancy,

 HCPCS/CPT Codes G0438 – Annual wellness visit; includes a personalized prevention plan of service (PPPS), initial visit G0439 – Annual wellness visit, includes a personalized prevention plan of service (PPPS), subsequent visit Who Is Covered All Medicare beneficiaries who are both, Not within 12 months after the effective date of their first Medicare Part B coverage period Have not received an Initial Preventive Physical Examination (IPPE) or AWV within the past 12 months Frequently Used ICD Z00.00 - Encounter for general adult medical examination without abnormal findings Z00.01 - Encounter for general adult medical examination with abnormal findings Z00.121 - Encounter for routine child health examination with abnormal findings Z00.129 - Encounter for routine child health examination without abnormal findings Frequency Once in a lifetime for G0438 (first AWV) Annually for G0439 (subsequent AWV) Medicare Beneficiary Pays Copayment/coinsurance waived Deductible waived

Coverage without cost-sharing available for eligible people with Medicare, Medicaid, CHIP, and Most Commercial Health Insurance Coverage Following the FDA’s recent action that authorized a booster dose of the Pfizer COVID-19 vaccine for certain high-risk populations and a recommendation from the CDC, CMS will continue to provide coverage for this critical protection from the virus, including booster doses, without cost sharing. Beneficiaries with Medicare pay nothing for COVID-19 vaccines or their administration, and there is no applicable copayment, coinsurance, or deductible.  In addition, thanks to the American Rescue Plan Act of 2021, nearly all Medicaid and CHIP beneficiaries must receive coverage of COVID-19 vaccines and their administration, without cost-sharing. COVID-19 vaccines and their administration, including boosters, will also be covered without cost-sharing for eligible consumers of most issuers of health insurance in the commercial market.  CMS continues to explore wa