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24.3.12.10 Preventive Care Services
The CSHCN Services Program may reimburse for preventive health-care services. Providers should submit claims with the following CPT E/M codes and include the appropriate diagnosis code (V202, Routine infant or child health check or V700, Routine general medical examination at a health-care facility):
Providers may be reimbursed for an acute care visit on the same day as a preventive care visit. The acute care visit should be billed as an established patient visit. Modifier 25 may be used to describe circumstances in which a visit was provided at the same time as other separately identifiable services (e.g., preventive visits, minor procedure). This modifier may be appended to the evaluation code when the services rendered are distinct, provided for different diagnosis, or are performed for different reasons. Both services must be documented as distinct and documentation must be maintained in the medical record and made available to the CSHCN Services Program upon request. Vaccinations, vaccine administration codes, and laboratory services may be billed in addition to the preventive care E/M code.
The CSHCN Services Program reimburses for only one preventive health visit per day per client for any provider. The program does not cover family planning services and inpatient newborn examinations.
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