Monday, July 12, 2010

colonoscopy V codes - Clinical Preventive Care Services

Clinical Preventive Care Services V Codes




Colonoscopy
V70.0
V70.5
V70.9
Proctosigmoidoscopy/sigmoidoscopy once every three to five years beginning at age 50.
Individuals at average risk for colon cancer:
  • Colonoscopy once every 10 years beginning at age 50.
Individuals at increased risk for:
  • Hereditary non-polyposis colon rectal cancer syndrome: Colonoscopy once every two years beginning at age 25, or five years younger than the earliest age of diagnosis for colorectal cancer in an affected relative, whichever is earlier; then annually after age 40.
  • Familial risk of sporadic colorectal cancer: Colonoscopy should be performed every three to five years, beginning 10 years earlier than the youngest affected relative.
There is no copayment or cost-share required for TRICARE Prime, Standard and TRICARE Extra beneficiaries.

Note: Computed tomographic colonography (CTC) is covered as a colorectal cancer screening only when an optical colonoscopy is medically contraindicated or cannot be completed due to a known colonic lesion, structural abnormality, or other technical difficulty is encountered that prevents adequate visualization of the entire colon. CTC is not covered as a colorectal cancer screening for any other indication or reason.
Mammograms (screening)
V70.0
V70.5
V70.9
Performed annually for women over the age of 39 (baseline at age 35 for high risk, then annually).

There is no copayment for TRICARE Prime, TRICARE Standard and TRICARE Extra beneficiaries.

Note: The mammogram and add-on codes must be submitted on the same claim if performed on the same date of service.
Optometry (eye exams)
V72.0
Active Duty Service Members (ADSMs)
  • TRICARE Prime ADSMs must receive all vision care at a military treatment facility (MTF) unless specifically referred to a network provider (or non-network provider if a network provider is not available).
  • TRICARE Prime Remote ADSMs may obtain a comprehensive eye examination from a network provider as needed to maintain fitness-for-duty status without an authorization.
Active Duty Family Members (ADFMs)
  • One routine eye exam to check for vision and diseases per calendar year, regardless of TRICARE program option.
  • Medically necessary care for injuries to the eye is covered.
Retired Service Members and Their Families(includes all beneficiaries other than ADSMs and ADFMs)
  • If enrolled in TRICARE Prime, one routine eye exam to check for vision and diseases every two years (except for diabetic patients, see below).
  • If using TRICARE Standard, TRICARE Extra, or TRICARE For Life, no coverage (except for well-child benefit and diabetic patients, see below).
  • Medically necessary care for injuries to the eye is covered.
Well-Child BenefitFor all TRICARE-eligible infants and children up to age 6:
  • Infants may receive one eye and vision screening1 during routine exam at birth and approximately 6 months of age under the well-child benefit. Use V20.2 for eye exams under the well-child benefit.
  • Children may receive two pediatric routine eye exams2 between the ages of 3 and 6 years under the well-child benefit (use V20.2).
Diabetic Patients
Diabetic patients at any age are allowed one routine eye examination each calendar year.
      
Note: For TRICARE Prime enrollees, a primary care manager (PCM) or Humana Military referral is not needed, but TRICARE Prime beneficiaries must see an MTF or network optometrist or ophthalmologist. The V code can be used for annual exam; however, if a medical condition is identified, use medical diagnosis CPT codes.
Pap Smears
V72.3
V76.2
Annually for women over the age of 18 (younger if sexually active). No PCM or Humana Military referral or copayment is required for TRICARE Prime beneficiaries, but they must use a network provider.
         
There is no copayment or cost-share required for TRICARE Prime, TRICARE Standard and TRICARE Extra beneficiaries.
Regular Immunizations
V20.2
(includes well-child check)
Immunizations should be administered at age-appropriate doses as suggested by the current schedule of recommended vaccines by the Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices.
School Physicials (Note:  a sports-related physical exam is not a covered benefit)
V70.0
V70.3
V70.5
V70.9
TRICARE-eligible dependents who are at least 5 years old and less than 12 years old may get physical exams that are required by a school in connection with enrollment as a student in that school. This benefit does not include physical exams that may be required by the school to participate in school sports. Children ages 12 and older are authorized only if a physical is required.
     
TRICARE Prime beneficiaries do not have a copayment, but they must use a network provider.
     
TRICARE Standard and TRICARE Extra beneficiaries will pay the applicable cost-shares and deductibles.
Well-Child Visits
V20.2 Includes routine newborn care, comprehensive health promotion (birth to 6 years) and disease prevention exams, vision and hearing screenings, height/weight/head circumference, routine immunizations (according to CDC guidelines), and developmental/behavioral appraisals (according to American Academy of Pediatrics).

There is no copayment or cost-share required for TRICARE Prime, TRICARE Standard, and TRICARE Extra beneficiaries.

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