Child Health and Disability Prevention (CHDP) Program Code Conversion

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1 Child Health and Disability Prevention (CHDP) Program Code Conversion Health s All s are effective for dates of service on or after July 1, (Select s for laboratory-only providers with effective date February 1, 2017.) CHDP local billing s B1 Autism screening New CHDP national billing s Development screening (for example, developmental milestone survey, speech and language delay screen), with scoring and documentation, per standardized instrument es B3 B4 01 Psychosocial/behavioral Psychosocial/behavioral re History and physical exam Health and behavior (for example, healthfocused clinical interview, behavioral observations, psychophysiological monitoring, and health-oriented questionnaires), each 15 minutes face-to-face with patient; initial Re Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk fact reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; infant (age under 1 year) early childhood (age 1 through 4 years, 11 months) late childhood (age 5 through 11 years, 11 months) adolescent (age 12 through 17 years, 11 months) through (20 years, 11 months) Page 1 of 15

2 Health s, continued CHDP local billing s History and physical exam Dental / referral New CHDP national billing s Periodic comprehensive preventive medicine, re-evaluation and management of established patient; infant (age under 1 year) early childhood (age 1 through 4 years, 11 months) late childhood (age 5 through 11 years, 11 months) adolescent (age 12 through17 years, 11 months) through (20 years, 11 months) 03 Nutritional Z71.3 Dietary counseling and surveillance Physical activity Physical activity Anticipatory guidance health education Developmental Z02.5 Participation in sport Z71.82 Exercise counseling Documentation in the medical record clearly needs to support anticipatory guidance provided for nutrition and physical activity along with types of guidance provided es Included in E&M preventive medicine health Included in E&M preventive medicine health Included in E&M preventive medicine health Included in E&M preventive medicine health Page 2 of 15

3 Health s, continued CHDP local billing s New CHDP national billing s 07 Hearing, audiometric Screening test, pure tone, air only Hearing, audiometric Pure Tone audiometry (threshold); air only es Labs and other CHDP local billing s 09 Urine dipstick New CHDP national billing s Urinalysis by dipstick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, ph, protein, specific gravity, urobilinogen, and any number of these constituents; non-automated, with microscopy 12 TB, Mantoux test Skin test, tuberculosis, intradermal A1c POC testing Finger stick in provider office BMI percentile Z68.51 pediatric less than 5th percentile BMI percentile Z68.52 pediatric 5th to < 85th percentile BMI percentile Z68.53 pediatric 85th to 95th percentile BMI percentile Z68.54 pediatric 95th percentile Chlamydia screening via urine Urinalysis with Genprobe APTIMA combo 2 urine collection device; infectious agent detection by nucleic acid (DNA or RNA); chlamydia trachomatis, amplified probe technique es Page 3 of 15

4 Vaccines The CPT-4 vaccine s for CHDP vaccines are listed in the following table. Effective July 1, 2017 CHDP claims require SL (state supplied vaccine) on claims submitted for vaccines supplied by Vaccine for Children (VFC) programs. Current CHDP local billing s New CHDP national billing s M1, M2, M3 M4, M5, M6 33 Bexsero (MenB vaccine) Trumenba (MenB vaccine) Measles/mumps/ rubella (MMR) 34 Measles, purchased 36 Rubella 38 HIB CV Polio, inactivated Hepatitis B, low-risk was deleted in 2015 was deleted in 2015 was deleted in 2015 CVX s for Meningococcal recombinant protein and outer membrane vesicle vaccine, serogroup B (MenB), 2 dose schedule, Meningococcal recombinant lipoprotein vaccine, serogroup B (MenB), 3 dose schedule, Measles, mumps and rubella virus vaccine (MMR), live, subcutaneous Poliovirus vaccine, inactivated, (IPV), subcutaneous or Hepatitis B vaccine, (HepB), pediatric/adolescent dosage, 3 dose schedule, Page 4 of 15

5 Current CHDP local billing s 41 and Hepatitis B immune globulin (HBIG) Hepatitis B, high-risk, adult DTaP Varicella Measles/mumps/ rubella (MMR), adult Hepatitis B, high risk, adult Varicella Influenza SL- add for state New CHDP national billing s CVX s for Hepatitis B immune globulin (HBIg), human, Hepatitis B vaccine, (HepB), adolescent, 2 dose schedule, Diphtheria, tetanus toxoids, and acellular pertussis vaccine (DTaP), Varicella virus vaccine (VAR), live, subcutaneous Measles, mumps and rubella virus vaccine (MMR), live, subcutaneous Hepatitis B vaccine (HepB), adult dosage, 3 dose schedule, Varicella virus vaccine (VAR), live, subcutaneous trivalent (IIV3), split virus, preservative free, Page 5 of 15

6 Current CHDP local billing s New CHDP national billing s 53 Influenza Influenza Influenza Influenza Influenza Influenza Pneumococcal polysaccharide (23PS) CVX s for trivalent (IIV3), split virus, quadrivalent (cciiv4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 ml dosage, quadrivalent (IIV4), split virus preservative free, quadrivalent (IIV4), split virus preservative free, quadrivalent (IIV4), split virus, trivalent (IIV3), split virus, Pneumococcal polysaccharide vaccine, 23-valent (PPSV23), adult or immunosuppressed patient dosage, subcutaneous or Page 6 of 15

7 Current CHDP local billing s 56 Hepatitis B/Hib combination 58 Td adult DT pediatric Td adult PF HIB CV 64 Polio, inactivated Hepatitis A Hepatitis A, adult was deleted was deleted New CHDP national billing s CVX s for Tetanus and diphtheria toxoids adsorbed (Td), preservative free, Diphtheria and tetanus toxoids adsorbed (DT), Tetanus and diphtheria toxoids adsorbed (Td), preservative free, Poliovirus vaccine, inactivated, (IPV), subcutaneous or Hepatitis A vaccine (HepA), pediatric/adolescent dosage, 2 dose schedule, Hepatitis A vaccine (HepA), adult dosage, Page 7 of 15

8 Current CHDP local billing s 67 Prevnar/PCF7 68 DTaP-HepB-IPV , 73 Meningococcal conjugate (MCV4) Meningococcal conjugate (MCV4) FluMist Tdap booster was deleted New CHDP national billing s CVX s for Diphtheria, tetanus toxoids, acellular pertussis vaccine, hepatitis B, and inactivated poliovirus vaccine (DTaP-HepB-IPV), Meningococcal conjugate vaccine, serogroups A, C, Y and W-135, quadrivalent (MenACWY) Meningococcal conjugate vaccine, serogroups A, C, Y and W-135, quadrivalent (MenACWY), trivalent, live (LAIV3), intranasal Tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap), Page 8 of 15

9 Current CHDP local billing s 74 MMRV , 77, 78 Rotavirus, 3 doses, oral Quadrivalent human papillomavirus (HPV) Tdap Influenza, inactivated, preservative-free Rotavirus, 2 doses, oral DTaP-Hib-IPV New CHDP national billing s CVX s for Measles, mumps, rubella, and varicella vaccine (MMRV), live, subcutaneous Rotavirus vaccine, pentavalent (RV5), 3 dose schedule, live, oral Human papillomavirus (HPV) vaccine, types 6, 11, 16, 18, quadrivalent (4vHPV), 3 dose schedule, Tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap), trivalent (IIV3), split virus, preservative free, Rotavirus vaccine, human, attenuated (RV1), 2 dose schedule, live, oral Diphtheria, tetanus toxoids, acellular pertussis vaccine, Haemophilus influenza type B, and inactivated poliovirus vaccine (DTaP-IPV/Hib), Page 9 of 15

10 Current CHDP local billing s 83 DTaP-IPV , 86, Influenza, H1N1 vaccine Bivalent human papillomavirus (HPV2) Pneumococcal 13- valent conjugate (PCV13) Pneumococcal polysaccharide (23PS) Meningococcal/Hib (MenHibrix) was deleted New CHDP national billing s CVX s for Diphtheria, tetanus toxoids, acellular pertussis vaccine and inactivated poliovirus vaccine (DTaP-IPV), Human papillomavirus (HPV) vaccine, types 16, 18, bivalent (2vHPV), 3 dose schedule, Pneumococcal conjugate vaccine, 13 valent (PCV13), Pneumococcal polysaccharide vaccine, 23- valent (PPSV23), adult or immunosuppressed patient dosage, subcutaneous or Meningococcal conjugate vaccine, serogroups C & Y and Hemophilus influenza type b vaccine (Hib-MenCY), 4 dose schedule, Page 10 of 15

11 Current CHDP local billing s 93, 94, 95 9-valent human papillomavirus (HPV9) New CHDP national billing s CVX s for Human papillomavirus vaccine types 6, 11, 16, 18, 31, 33, 45, 52, 58, nonvalent (9vHPV), 3 dose schedule, quadrivalent (IIV4), split virus, preservative free, intradermal Hepatitis A and hepatitis B vaccine (HepA-Hep B), adult dosage, Haemophilus influenza type b vaccine (Hib), PRP-OMP conjugate, 3 dose schedule, Hemophilus influenza type b vaccine (Hib), PRP-T conjugate, 4 dose schedule, trivalent (IIV3), split virus, preservative free, Page 11 of 15

12 Current CHDP local billing s New CHDP national billing s CVX s for trivalent (RIV3), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, Rabies vaccine, Hepatitis B vaccine (HepB), dialysis or immunosuppressed patient dosage, 3 dose schedule, Required services to be completed annually by PCP Tests or order/screenings/visits A1c testing Serum potassium and serum creatinine Urine tests for protein (random, spot or dipstick) Population Frequency Timeframe PCP responsibility Members ages diagnosed with diabetes Members taking an Ace, Arb or diuretic Members diagnosed with diabetes Annually: until controlled (<8) Annually Annually Measurement year Measurement year Measurement year Order or complete via point of contact (POC) and bill. Follow up if out of range. Order and follow up until complete Complete in office with dipstick, bill or order lab Page 12 of 15

13 Required services to be completed annually by PCP, continued Tests or order/screenings/visits Population Frequency Timeframe PCP responsibility Pap smear Women ages Every 3 years Measurement year and 2 years prior Complete or refer to gynecologist Breast cancer screening referrals Immunizations FOBT Chlamydia screening Depression screening Women ages Per periodicity table Members who refuse colonoscopy or sigmoidoscopy Women ages who are sexually active (urine) Members ages 12 and older Every 2.25 years See periodicity schedule Annually or every 3 years if using FIT DNA test Annually for sexually active members Annually Service needs to take place between October 1, 2 years prior to measurement year, to December 31 of the measurement year Measurement year for ifobt. FIT DNA is measurement year and 2 years prior Measurement year Measurement year Refer or order Complete and bill Provide kit or order Order and follow up until complete Complete, bill and follow up with positive screenings BMI s Members ages Annually Measurement year Complete and bill Well-child exams Members ages 3-6 Annually Measurement year Complete and bill Eye exam referrals Members ages diagnosed with diabetes Annually Measurement year Referral request for documentation for reporting 2022F at time of review with member. Page 13 of 15

14 Required services to be completed annually by PCP, continued Tests or order/screenings/visits Eye exam using eye Pac machines Functional status Population Frequency Timeframe PCP responsibility Members ages diagnosed with diabetes Members ages 66 and older Annually Measurement year If device in house complete technical component and bill with modifier. Eye care provider to bill with professional component or refer to network eye care provider. This is covered under the medical benefit. Annually Measurement year Complete and bill Advance care planning discussion Medication review Medication reconciliation post hospitalization Pain s Members ages 66 and older Members ages 66 and older Members ages 18 and older Members ages 66 and older Annually Measurement year Complete and bill Annually Measurement year Complete and bill within 30 days of discharge Within 30 days of discharge Complete and bill Annually Measurement year Complete and bill Blood pressure (BP) monitoring Members ages and older Each visit Takes last BP of the measurement year Complete and bill DEXA scan orders Members ages who suffered a fracture Within 6 months of fracture Fractures that occur between July 1 of prior year to June 30 of current measurement year Order and follow up Page 14 of 15

15 Required services to be completed annually by PCP, continued Tests or order/screenings/visits Nutrition and counseling Physical activity and counseling Osteoporosis medications Population Frequency Timeframe PCP responsibility Members ages 3-17 Annually Measurement year Complete and bill Members ages 3-17 Annually Measurement year Complete and bill Members ages who suffered a fracture Within 6 months of fracture Fractures that occur between July 1 of prior year to June 30 of current measurement year Order Page 15 of 15

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