How PreventionPays™ Works
Current PreventionPays™ Programs
PreventionPays™ currently offers the following health assessments for primary care and OB/GYN physicians delivering preventive services to adults:
We are always interested in developing other health assessments for the PreventionPal™ system. If you have an idea for a screening program you would like us to develop for your practice or healthcare speciality, please contact us for an assessment.
Getting Paid for Preventive Services
CPT codes and Medicaid Billing
Very few primary care physicians and OB/GYNs are aware of the numerous prevention codes available to them. We often hear from our providers, "How can I bill for something that I don't spend time doing?" Preventive services do not always require a physician's direct time. In an effort to increase prevention in primary care, several codes have been identified to cover the Administrative and Interpretive portion of health screening. This would be staff time, to identify the proper screening tool, administer the screen, and score it. Most providers assume that billing will only begin if and when, risk is identified. This is a common and often costly misperception. We know you are busy and have limited time to research billing codes for every service your office delivers, however, we can help you and your staff by identifying CPT codes for each assessment you implement. For an excellent example of potential revenue stemming from the Bone Loss Screening Module, click here.
For example: AMA recommends...
- MRS (menopausal rated symptomology) CPT code 99396, "Periodic comprehensive preventive medicine..., established patient; 40-64 years"
- UBS (urological assessment) CPT code 99395, "Periodic comprehensive preventive medicine, established patient; 18-39 -years," or 99396, "Periodic comprehensive preventive medicine..., established patient; 40-64 years" depending on age of patient
- EPDS (Edinburgh Postpartum Depression Scale) use Code 99420, specific to the administration and interpretation of health risk assessment instruments
- BLA (Bone Loss Assessment) use Code 99420, specific to the administration and interpretation of health risk assessment instruments. If patient is determined to be at risk for osteopenia or osteoporosis, use proper level E/M (99201-99215) in addition to the A/I code
AUDIT or DAST use the following codes:
99408: Alcohol and/or substance (other than tobacco) abuse structured screening (e.g., AUDIT, DAST), and brief intervention (SBI) services of 15 to 30 minutes, and 99409: Alcohol and/or substance (other than tobacco) abuse structured screening (e.g., AUDIT, DAST), and brief intervention (SBI) services greater than 30 minutes.
- When billing Medicare use G0396: Alcohol and/or substance (other than tobacco) abuse structured assessment (for example, AUDIT, DAST), and brief intervention of 15 to 30 minutes. Use G0397 for greater than 30 minutes. For more information about proper coding for adult preventive services, click here.