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Preventive services: 2017 policy and coding updates effective May 1, 2017

05/03/2017

We're making other updates to our preventive services guidelines for diagnostic mammography, colon cancer screening, assessment for fall prevention and immunizations. These updates will only apply to commercial members with individual and group plans who receive the services from in-network ConnectiCare health care providers. These changes do not affect your patients with employer-sponsored plans for municipalities.

  • Mammography: We will no longer accept diagnostic mammography codes as preventive services without member cost-shares.
    • Mammography as a preventive service will be limited to screening mammography codes CPT 77067 or G0202 until Dec. 31, 2017.
    • HCPCS codes G0204 and G0206 are diagnostic and not included in screening mammography as of Jan. 1, 2017.
  • Colon cancer screening: We will limit the sigmoidoscopy procedures we accept as preventive and will add computed tomographic (CT) colonography as a preventive service in appropriate circumstances.
    • Sigmoidoscopy procedures included under colon cancer screening will be limited to CPT codes 45330, 45331 and 45333.
    • We will add CT colonography, also known as virtual colonoscopy, CPT code 74263, as a preventive service, but preauthorization for the service will be required.
  • Physical therapy for fall prevention: This preventive service will be changed to "assessment for fall prevention."
    • The assessment codes under this service will be included under the annual preventive screening service.
    • Any physical therapy after the assessment will not be considered preventive and a member cost-share will apply.
  • Medical nutrition therapy: We will be adding CPT code G0270, medical nutrition therapy by a telehealth provider, as a preventive service without cost-share.
  • Immunizations: We will be updating our preventive vaccine codes to include new codes and remove obsolete ones.