There are thirty four preventive services, broken down by age group and gender, that insurers pay physicians to perform but for which the cost is not passed on to patients. These services include vaccines; diet, tobacco and alcohol counseling; mammography; diabetes screening; colonoscopies; Pap smears; and cholesterol screening. Primary care physicians not currently providing these services may want to further investigate these services.
What Preventive Services are Free to Insured Patients?
The Patient Protection and Affordable Care Act spells out what preventive visits have “cost-sharing waived” — meaning that most insured patients are not required to shell out a co-pay or deductible to receive them.
Preventive services for children 6-36 months
- Influenza virus vaccine (preservative-free) — intramuscular use
- Influenza virus vaccine — intramuscular use
Preventive service for individuals age 2 and older
- Pneumonococcal polysaccharide vaccine — subcutaneous or intramuscular use
Preventive services for individuals age 3 and older
- Influenza virus vaccine (split, preservative-free) — intramuscular use
- Influenza virus vaccine (split) — intramuscular use
Preventive services for children younger than 5
- Pneumococcal vaccine — intramuscular use
Preventive services for children age 6 and older
- Screening and counseling for obesity
Preventive services for adolescents age 12-18
- Screening for HIV
- Hepatitis B vaccine (2-dose) — intramuscular use
- Hepatitis B vaccine (3-dose) — intramuscular use
Preventive services for women
- Screening Pap test and cervical cancer
- Counseling for tobacco
Preventive service for women 20 and older
- Screening for cholesterol abnormalities
Preventive service for women age 40-plus
- Screening for breast cancer (mammography)
Preventive service for women 65 and older
- Screening for osteoporosis
Preventive service for men non-age specific
- Screening for prostate cancer
Preventive service for men age 20-35
- Screening for cholesterol abnormalities
Preventive service for men age 35-79
- Screening for cholesterol abnormalities
Preventive service for men age 65-75
- Screening for abdominal aortic aneurysm
Preventive services for adults
- Screening for diabetes
- Counseling for a healthy diet
- Screening for HIV
- Screening and counseling for obesity
- Screening for glaucoma
- Screening for alcohol and/or substance abuse
Preventive service for adults age 50-75
- Screening for colorectal cancer
Preventive services for individuals non-age specific
- Influenza virus vaccine (live) — intranasal use
- Influenza virus vaccine (split, preservative-free), enhanced immunogenicity — intramuscular use
- Influenza virus administration/counseling
- Pneumococcal conjugate vaccine — intramuscular use
- Hepatitis B vaccine (3-dose schedule), dialysis or immunosuppressed patient — intramuscular use
- Hepatitis B vaccine — intramuscular use
- Hepatitis B vaccine (4-dose schedule), dialysis or immunosuppressed patient — intramuscular use
- Counseling for tobacco
Screening for cholesterol abnormalities in men is divided into two categories based on age.
Source: “CPT Code Pocket Guide: Preventive services with cost-sharing waived,” American Medical Association (www.ama-assn.org/go/cptpreventiveservices).
For additional information, please call Anne M Dunne, Director of Healthcare Consulting at Grassi & Co., 516 336-246 or email Anne directly, adunne@grassicpas.com.
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